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Objectives: The study aims to determine the influence of the efficiency of the cervical cancer program on the budget execution during the COVID-19 pandemic years 2020- 2021. Method(s): Estimating the screened women and using a micro-costing analysis to estimate the cost of treating precancerous lesions and cervical cancer in the pandemic and a non-pandemic scenario during 2020 -2021. Finally, the estimation of the budget execution for the cervical cancer program led by the Ministry of Health in the pandemic and non-pandemic scenarios. The estimation in the study was through two scenarios determined, the pandemic and non-pandemic scenarios during the years 2020 and 2021. After that, it was determined the number of screened and non-screened women. The next step was the cost estimation of the low-grade squamous intraepithelial lesion (LSIL), high-grade squamous intraepithelial lesions (HSIL), and cervical cancer at different stages. Therefore, this information is necessary for the Peruvian Ministry of Health to provide healthcare services to patients who did not get screened in the years 2020 and 2021. Result(s): The non-pandemic scenario would be spent USD 33,547,185 and USD 37,428,997 in 2020 and 2021, respectively. Conversely, in the pandemic scenario, spent USD 9,934,440 and USD 23,762,073 by 2020 and 2021. Therefore, by 2020 must be spent 68.7% of the budget, but only had been spent 20.3%. Moreover, in 2021, only 46.7% of the budget was spent when it should be 73.6% of the total budget. Therefore, USD 39,496,476 and USD 27,114,114 were not executed in 2020 and 2021, respectively. Conclusion(s): A total of USD 66,610,590 was the non-executed budget for the cervical program and needs to be reallocated in the following years to provide healthcare services to the women who did not get access to screening and treatment.Copyright © 2023
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Background/Aims Psoriatic arthritis (PsA) is a multi-system disease with a range of management options. Treatment may vary by geographic location. We compared disease characteristics and prescribing practices in the UK and Europe in the post-Covid era. Methods The ASSIST study was a cross-sectional observational study of PsA patients aged 18 years and older selected from 24 centres across 5 countries (UK, France, Germany, Italy and Spain) between July 2021 and March 2022 (IRAS: 287039). Patients attending a face-to-face appointment with a diagnosis of PsA made by a rheumatologist were selected by systematic sampling at each centre and treated in routine clinical practice. Patient and disease characteristics, current treatment and treatment decisions (medications unchanged, switched, added or reduced) were recorded. The analysis was descriptive, with no imputation of missing data. Results 503 patients were included, with arthritis subtype, patient age, disease activity and duration shown (Table 1). Physician- and patient-reported disease severity was highest in the UK, where median patient age was lowest. Conventional synthetic (cs) DMARDS constituted a higher percentage of current PsA treatment in UK than continental Europe (66.4% vs 44.9%), whereas biologic use was more frequent in Europe (68.1% vs 36.4%). Adalimumab was the most commonly used biologic in the UK and Spain. Adalimumab and secukinumab were equally used in Germany, and ixekizumab and adalimumab were joint-first in Italy. Implementing change to the current PsA treatment was most common in the UK, predominantly being a treatment increase. This may reflect the higher level of disease activity or younger patient age in the UK than other countries, as treatment escalation is more likely earlier in the disease course. In the UK, treatment escalation was more commonly achieved by medication addition (26.2%) than medication switch (14%) or dose increase (7.5%). In Europe, medication addition and switch were of more similar frequency (10.9% vs 9.85%). Conclusion Disease characteristics and treatment strategies varied between countries, but particularly between UK and the rest of Europe. In contrast to mainland Europe, csDMARDs predominated in the UK, perhaps reflecting current NICE guidelines. Treatment escalation was most common in the UK, in keeping with higher disease activity. (Table Presented).
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The transition from secondary education to university education has become a critical moment for the lifestyle of young people, especially for the practice of physical activity. Therefore, the main objective of the present study was to assess the levels of physical activity in university students, by correlating the results of the IPAQ-SF and the different physical fitness variables (Eurofit). The sample consisted of 194 students of the Primary Education Degree, with a mean age of 21.37 +/- 2.66 years. The main results obtained reflect the direct relationship between the practice of physical activity in general, and vigorous physical activity in particular, and optimal physical fitness of university students, linked above all to the strength component. As for the comparison between prepandemic ( 18/19) and post-pandemic (21/ 22) university students, the increase in physical activity after the pandemic did not show substantial differences in the physical fitness components. In conclusion, these results should lead us to reflect on the influence of an active lifestyle on physical fitness, which has an impact on overall health status and quality of life.
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Nutrition plays a critical role in preventing, managing, and treating noncommunicable diseases;thus it is essential physicians be able to appropriately refer to and collaborate with interprofessional (IP) care team members, like registered dietitian nutritionists (RDNs). This study evaluated the effectiveness of the Nutrition Clinical Experience (NCE) to increase first-year medical students' (M1s′) understanding of RDNs' roles on the IP healthcare team, common reasons to consult a RDN, and interventions RDNs implement. M1s participated in a 1.5 or 2-h IP clinical observation experience with an outpatient or inpatient RDN. Due to the COVID-19 pandemic, virtual, in-person, and hybrid experiences were offered. Before the experience, students were provided a handout with an overview of a RDN's role, description of medical nutrition therapy, and example cases. During the NCE students shadowed a RDN as they conducted outpatient encounters or inpatient rounds, and were encouraged to discuss real or sample patient cases. Students and RDNs answered post-experience 5-point Likert surveys and free-response questions to evaluate experience effectiveness. Of responding students, 96% agreed or strongly agreed the experience helped them learn about RDNs' roles and 99% agreed or strongly agreed they were more likely to involve a RDN in patient care following the experience. Additionally, after the experience, 78% of participating students identified at least one common reason to consult a RDN and 70% described at least three interventions that RDNs implement. All responding RDNs agreed or strongly agreed the experience is valuable to students and 85% agreed or strongly agreed the NCE allowed them to communicate their roles to students. The ability to deliver the experience virtually makes it a useful curricular program for schools without on-site RDNs to engage preclinical students in IP experiences. This report includes materials required for the experience. © 2023 Elsevier Inc.
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During the Covid-19 crisis, many networks have sprung up disseminating information. This study examines the influence of religion during the Covid-19 pandemic. It understands religion as a factor capable of mitigating frustrations and critical situations in society. To this end, a data mining analysis was developed for a set of 107,786 tweets collected from the social platform Twitter in the framework of user-generated content (UGC), linked to the Covid-19 related tweets published by @Pontifex and @Pontifex_es. To achieve this goal, hidden insight data extraction and sentiment analysis are carried out, along with the application of social network analysis (SNA) techniques. The main outcome of the study is the positive correlation between the repercussion of the Pope's tweets and the evolution of the Covid-19 incidence in Europe. Finally, the latent dirichlet allocation (LDA) algorithm identifies the relevant topics in the analysis. Copyright © 2022, IGI Global.
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Purpose: This study aims to provide a case example of two partner institutions and business faculty who creatively used a collaborative online international learning (COIL) experience during the height of the COVID-19 pandemic and transition to online learning to internationalize an undergraduate business class and use existing technology to offer a case study project to further students' global mindset. Design/methodology/approach: Using open-ended qualitative comments from an American college and a Peruvian university, researchers uncovered key themes from a virtual COIL-based learning experience offered as part of an international business class. Findings: Student end-of-course evaluation comments from both countries validated the success of the learning experience and value of working together with other students and faculty in a virtual setting. Research limitations/implications: Areas for future research are provided to extend these initial exploratory findings. However, the implications are clear that the methodology is also appropriate in nonpandemic situations and can quickly bring a global mindset to remote corners of the globe and ensure all students experience the "virtual” study abroad, even when there are travel limitations or budget restrictions for students or the institutions. Practical implications: The implementation detail provided can be easily replicated by other institutions with a global mindset and internationalization goals. Social implications: The proliferation of COIL-based experiences will impact how study abroad experiences are defined and offered in the future. Originality/value: While researchers have documented COIL experiences in the academic literature, their use during the COVID-19 pandemic, as often the only solution for on-going internationalization, has not been thoroughly studied or documented. In addition, the class activities further used team-based international workplace pedagogy, authentic engagement and technology. © 2023, Emerald Publishing Limited.
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The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) disease (COVID-19) has caused a large global outbreak and has had a major impact on health systems and societies worldwide. The generation of knowledge about the disease has occurred almost as fast as its global expansion. Very few studies have reported on the effects of the infection on maternal health, since its onset. The mother and foetus do not seem to be at particularly high risk. Nevertheless, obstetrics and maternal-foetal medicine practice have made profound changes in order to adapt to the pandemic. In addition, there are aspects specific to COVID-19 and gestation that should be known by specialists. In this review an evidenced-based protocol is presented for the management of COVID-19 in pregnancy.
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Background: Mortality associated with COVID-19 varies in various reports, with minimal data on the factors associated with in-hospital mortality. Objective: To identify the risk factors for in-hospital death of patients with COVID-19 in an intensive care unit (ICU) in Qatar. Methods: A retrospective observational study of patients confirmed with COVID-19 and admitted to the medical-surgical ICU at The Cuban Hospital was carried out from April 12, 2020, to September 12, 2020. From patients' electronic medical records, demographic, clinical, laboratory, and radiology data was collected. Results: 275 patients with COVID-19 were admitted to the ICU, and 32 (11.6%) died. 56.1% were men, and the mean age was 52.2 years. According to the univariate analysis, patients with diabetes mellitus with end-organ damage (37.5%), cardiovascular disease (31.3%), dementia (9.4%), kidney disease (28.1%), chronic obstructive pulmonary disease (31.3%), and higher Charlson index had higher mortality. According to the multivariate analysis, an increase of mortality risk by 9% was observed for each additional year of age (Odds ratio [OR] 1.09;95% confidence interval [CI] 1.04-1.14), patients on mechanical ventilation (OR 27.33;95% CI 3.21-232.46), and those with adult respiratory distress (OR 15.85;95% CI 1.45-172.82) and elevated procalcitonin (OR 7.30;95% CI 1.25-42.58), and the PiO2/FiO2 ratio between 100 and 299 decreased the risk of death by 92% (OR 0.08;95% CI 0.02-0.39), in comparison to a PiO2/FiO2 ratio less than 100 or greater than 300. Conclusion: The study provides evidence about the risk of mortality among COVID-19 patients with a significant contribution of age, respiratory failure, and co-infections.
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As it does every year, the CAV-AEP publishes the update of its recommendations for the use of vaccines in children, adolescents and pregnant women residing in Spain. The 2 + 1 schedule is maintained in infants (at 2, 4 and 11 months), including preterm infants, with the hexavalent vaccine (DTaP-IPV-Hib-HB) and the pneumococcal 13-valent conjugate vaccine. A booster dose with DTaP-IPV is needed at 6 years for those who received the 2 + 1 series with hexavalent vaccine as infants, in addition to 1 dose of dTap in adolescence. Routine vaccination of pregnant women with a dose of dTap is recommended in each pregnancy, preferably between weeks 27 and 32 of gestation, although can be given from 20 weeks if there is risk of preterm delivery. All infants should receive the rotavirus vaccine (2-3 doses) and the 4 CMenB vaccine (2 + 1 series). All children aged 6-59 months should be vaccinated against influenza each year, in addition to risk groups from 6 months. The MenACWY vaccine should be given routinely at 12 months of age and in adolescence between ages 12 and 18 years. The recommendations for the MMR vaccine (12 months and 3-4 years) and varicella vaccine (15 months and 3-4 years) also remain unchanged, using the MMRV vaccine for the second dose. Recommendations for the use of SARS-CoV-2 vaccines in the paediatric age group will be updated periodically on the CAV-AEP website. The HPV vaccine is indicated in all adolescents, regardless of sex, at age 12 years. Novelties include the recommendation of routine administration of nirsevimab to neonates and infants aged less than 6 months for passive immunization against RSV, and the recommendations regarding the hexavalent vaccine are consolidated in a single section. Copyright © 2022 Asociacion Espanola de Pediatria
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Within the multiple urban-rural interactions that make up the territorial dynamics, this article addresses and identifies how mobility relations are produced between neighbouring municipalities that share services. The aim of this research is to carry out a diagnosis of the current mobility situation in an area of low population density in order to identify the needs and possible shortcomings in this area. The initial identification of weaknesses is essential in order to propose solutions for rural mobility. The methodology adopted is based on two distinct lines of work: (1) analysis of information in open data from public repositories using geographic information system tools (GIS), and (2) surveys of citizens living in the study area. The results allude to the fact that the most transcendental problem in the study area is the lack of a quality collective public transport service that meets minimum utility requirements for users, a fact that generates a transfer towards the use of private vehicles. No serious parking, noise, pollution or road safety problems are observed;however, similar dynamics to other rural areas with low demographic density are confirmed, such as the age of the mobile fleet and an aging population with accessibility problems. The presence of new modes of transport (electric bicycles, personal mobility vehicles, and even electric vehicles) is practically insignificant. Both teleworking and the new consumer habits associated with online shopping have not yet had a strong impact. Political decision making by public administrations is identified as a direct application of this research.
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The coronavirus pandemic (COVID-19), due to severe acute respiratory syndrome coronavirus-2, is a major current public health problem worldwide. It is crucial to recognize that recovery of patients with COVID-19 does not end with the hospital discharge but rather begins, and improving daily physical activity (PA) seems crucial to this recovery. Thus, characterizing PA in patients with COVID-19 after discharge should be a priority in public health. Furthermore, reporting the impact of COVID-19 on the functional status and PA in the long-running follow-up of patients would allow to understand the evolution and prognosis of the disease and develop a strategy of its management [1]. Hence, we aim to investigate PA and functional status in patients who suffered from COVID-19 across the severity of the disease. This paper describes the algorithm developed for the estimation of PA from data collected with an inertial measurement unit (IMU) and the preliminary results of the objective evidence of the improvement of activity level over time. © 2022 IEEE.
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Journalists and communicators discovered Twitch in mid-2020, during the months of quarantine imposed by Covid-19, during which a large part of the population used the Internet to seek communication with the outside world that confinement prevented. Given its content, dedicated to e-sports, and the youth of its followers, this specialized social network had gone unnoticed by the general public for years. Having initially been a platform for broadcasting video games, thanks to the arrival of journalists it started to become a space for information and entertainment, with the creation of new channels aimed at a more adult audience. The aim of this paper is to analyse the presence of journalists and communicators on Twitch, how they structure their channels, the use they make of this platform compared to other similar platforms, the differences and similarities in their use of the platform compared to the streamers already present on Twitch and, finally, to evaluate whether Twitch meets the necessary conditions to become an appropriate medium for news communication. By looking at the content generated on Twitch by five journalists and communicators, we study how they adapt their channels to the common characteristics of the platform, which can be seen in the behaviours and content generated by video game creators. © 2022. Analisi. All Rights Reserved.
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This rapid expert consultation was produced by individual members of the Standing Committee for CDC Center for Preparedness and Response (SCPR). Its aim is to review and propose modifications to an initial draft list of critical federal capabilities presented by the Centers for Disease Control and Prevention (CDC) and the U.S. Food and Drug Administration (FDA) that are needed to evaluate real-world safety, effectiveness, equitable distribution, access, and use of medical countermeasures (MCMs) during a public health emergency (PHE). This effort draws from expert input, published literature, and lessons learned from previous public health emergencies, as well as the ongoing COVID-19 pandemic. National Academies of Sciences, Engineering, and Medicine. 2022. Rapid Expert Consultation on Critical Federal Capabilities Needed to Evaluate Real-World Safety, Effectiveness, and Equitable Distribution and Use of Medical Countermeasures During a Public Health Emergency. Washington, DC: The National Academies Press. https://doi.org/10.17226/26574. © 2022 National Academy of Sciences. All rights reserved.
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INTRODUCTION AND OBJECTIVES: The outbreak of COVID-19 has overwhelmed healthcare systems all over the world. The aim of this article is to describe the process of transforming the Vall d'Hebron University Hospital, the second largest hospital in Spain, into a COVID-19 centre coordinating response to the pandemic in its reference area. MATERIALS AND METHODS: The study draws on the experience of the authors in transforming the hospital into a comprehensive resource in response to the COVID-19 pandemic. The strategy is based on four central strategies: early planning, coordination of all healthcare agents in its reference area, definition of clear leadership roles, and the organisation of care based on multidisciplinary teams with minimal recruitment of new staff. RESULTS: The transformation strategy enabled the hospital to cope with the surge in patients without exceeding its capacity. During the response phases, which amounted to a period of 57 days, 3106 patients consulted the ER and 2054 were admitted, 346 of whom were treated at the ICU. To accommodate the number of adult COVID-19 patients, adult ICU availability was progressive increased by 371%, and ordinary beds increased by 240. A total of 671 staff members went on sick leave after testing positive for COVID-19. CONCLUSION: The transformation experience of the hospital provides insight into how effectively adapt the structures and functioning of large hospitals. The relevance of territorial coordination during the pandemic is stressed as an effective strategy that contributed coping the pandemic.
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COVID-19 , Adult , COVID-19/epidemiology , Hospitals, University , Humans , Pandemics , SARS-CoV-2 , Spain/epidemiologyABSTRACT
BACKGROUND AND AIMS: Acute kidney injury (AKI) is a common complication among patients hospitalized with COVID-19. The incidence of AKI is estimated to be around 5%-80%, according to the series, but data on renal function evolution is limited. Our main objective was to describe the incidence of AKI in patients with SARS-CoV-2 infection;secondarily, we analysed the severity of AKI and medium-term renal function evolution in these patients. METHOD: A retrospective observational study that included patients hospitalized a single hospital, diagnosed with SARS-CoV-2 infection, who developed AKI (March- May 2020). We register clinical and demographic characteristics, creatinine upon admission and prior to discharge, as well as creatinine and CKD-EPI glomerular filtration rate (eGFR) after at least 3 months after discharge. CKD was defined according to KDIGO stages based on the eGFR (G3-G5). The KDIGO classification was used to define and classify AKI. Recovery of kidney function was defined as difference in at discharge or post-hospitalization creatinine < 0.3 mg/dL with respect basal creatinine. The clinical follow-up ranged from admission to death or end of study. RESULTS: Of 258 patients hospitalized with SARS-CoV-2 infection, AKI occurred in 73 (28.3%). 63% (n = 46) were men;the mean of age was 69 years (57-76). DRA severity: 35 (48%) KDIGO-1, 15 (21%) KDIGO-2 and 23 (31%) KDIGO-3. The mean stay was associated with the severity of AKI: 7 days (3-11) for KDIGO-1, 11 days for KDIGO-2 (5-22) and 12 days (8-35) for KDIGO-3 (P = .02). The stage of CKD established differences in the severity of AKI: 66.6% (n = 6) of the patients with CKD G4-G5 presented AKI-KDIGO 3 versus only 25.0% (n = 4) in the CKD-G3 patients (P = .02). Admission to the ICU was more frequent in KDIGO 2-3 versus KDIGO-1 [39% (n = 15) versus 9% (n = 3);P < .01]. Of the 48 patients discharged, 30 (62.5%) had recovered their baseline renal function upon discharge. Only 2 are still on RRT after 8 months (2.7% of all patients). Of the 25 patients died (34% of patients with AKI) with a median time of 3 days from DRA diagnosis (1-8). Renal function of 35 patients was monitored, which correspond to 19 (54%) KDIGO- 1, 8 (23%) KDIGO-2, 8 (23%) KDIGO-3 stages. In these patients, analytical control starting 3 months after hospitalization revealed FG 66 (SD 30;56-76) mL/min/1.73 m2. We have not found differences in renal function between pre- and posthospitalization in related test. A total of 77% (n = 37) of discharged patients recovered their baseline renal function in the post-hospitalization control. CONCLUSION: The incidence of AKI in the context of COVID-19 in our series was 28.3%, with an associated mortality of 34.2%. Most of the patients presented with AKI KDIGO 1 (47.9%). The severity of AKI is associated with a longer hospital stay, admission to the ICU and the requirement for RRT. The advanced stages of CKD preadmission showed more severity of AKI. The maintenance in TRS in our series has been 2.7%. Patients who were discharged for recovery/improvement of COVID-19 had normalized kidney function during subsequent follow-up, regardless of the severity of the AKI developed on admission for COVID-19. (Figure Presented).
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Today educational settings face the challenge of connecting the curriculum that is taught in school with the students' reality outside the classroom. In that sense, art education can be especially relevant, allowing students to stablish affective and emotional links with this reality through a creative process. The project described in this paper promoted a creative and critical work about the degradation of the landscape in the vicinity of our secondary school. In order to internalize and to solve this problem students enrolled in music and visual arts classes worked through the paradigms of contextual art and critical pedagogy. The present text is structured around the art-based research model (Frayling, 1993;de Laiglesia, 2009), describing and conceptualizing the project and focusing in the concept of degraded beauty through four parts: context, concept, actions and publicity. After considering the teacher as a public intellectual, the object of the project was to generate a critical thinking in students from a theory-grounded perspective.
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Background: As nutritional requirements change with age, registered dietitian nutritionists (RDNs) play a critical role in maintaining older adults' quality of life. Preclinical medical students infrequently have opportunities to engage with and learn the roles and responsibilities of interprofessional (IP) team members. This study evaluated the effectiveness of a nutrition clinical experience to increase first-year medical students' (M1s') understanding of the roles of RDNs on the IP healthcare team. Methods: M1s at a tertiary care center participated in a required 1.5 or 2 hour IP clinical observation experience with an outpatient or inpatient RDN. Due to the COVID-19 pandemic, virtual, in-person, and hybrid experiences were offered. M1s and participating RDNs completed post-experience surveys. Results: Ninety M1s participated in the experience;89% completed a post-experience survey. Overall, 96% of responding M1s enjoyed the experience, 96% agreed the experience helped them understand RDN's roles, and 99% agreed they were more likely to involve a RDN in patient care following the experience. Of respondents, 35, 33, and 10 participated via a virtual, in-person, or hybrid experience, respectively. Although not statistically significant, there was a trend toward more agreement with in-person vs. virtual experiences related to experience enjoyment (100% vs 94%), experience helpfulness (100% vs 91%), and intentions to incorporate RDNs into future care (100% vs 97%). A significantly greater proportion of M1s discussed a real patient case when participating in-person compared to participating virtually (100% vs 71%, p<.05). Half of RDNs (6/12) completed a post-experience survey;all agreed the experience allowed them to clearly convey their roles and responsibilities. Conclusions: An IP clinical experience via virtual or in-person modalities is an effective pedagogical tool to improve M1s' understanding of RDN's roles. More work should be done to evaluate students' attitudes regarding in-person vs. virtual experiences. In-person experiences may provide greater opportunity for learning engagement through real-life patient case discussion.