Challenges of tele-rehabilitation in children with disabilities in initial education

This research deals with the tele-rehabilitation service for children with disabilities in a post-Covid-19 era. There has been a boom with new working models and adaptation to new challenges and experiences of professionals in rehabilitation therapies. With such services as the most effective way to treat psychomotor deficits in children with disabilities, Rehabilitation Centers have reconfigured their planning by offering hybrid care, but there is a lack of integration of ICT for the delivery of these services through agile approaches. Under an Action-Design methodology, a survey was designed and applied to therapists from five Rehabilitation Centers in Mexico;focused on knowing four relevant aspects: Rehabilitation Teleworking;ICT in therapeutic activity;Communication between parents and Rehabilitation centers;and Patients. From the result, it can be inferred that there is a high level of interest at THE initial education in technological training and a need for higher quality stimulation tools and resources.

Proteomic determinants of disease, mortality and sequelae in COVID-19 patients requiring invasive mechanical ventilation

Introduction: The molecular mechanisms linked to the pathology of severe COVID-19 and its outcomes are poorly described. Aim(s): To analyze the proteomic profile of bronchial aspirates (BAS) samples from critically ill COVID-19 patients in order to identify factors associated with the disease and its prognosis. Method(s): Multicenter study including 74 critically ill non-COVID-19 and COVID-19 patients. BAS was obtained by bronchoaspiration after invasive mechanical ventilation (IMV) initiation. Proximity extension assay (PEA) technology was used for proteomic profiling. Random forest (RF) statistical models were used to predict the variable importance. Result(s): After adjusting for confounding factors, CST5, NADK, SRPK2 and TGF-alpha showed differences between COVID-19 and non-COVID-19 patients. Reduced levels of ENTPD2 and PTN were observed in non-survivors, even after adjustment. AGR2, NQO2, IL-1alpha, OSM and TRAIL, were the top five strongest predictors for ICU mortality and were used to build a prediction model. PTN (HR=4.00) ENTPD2 (HR=2.14) and the prediction model (HR=6.25) were associated with higher risk of death. In survivors, FCRL1, NTF4 and THOP1 correlated with lung function (DLCO levels) 3-months after hospital discharge. Similar findings were observed for Flt3L and THOP1 and radiological features (TSS). The proteins identified are expressed in immune and non-immune lung cells. A poor control of viral infectivity and an inappropriate reparative response seems to be linked to the disease and fatal outcomes, respectively. Conclusion(s): In critically ill COVID-19 patients, specific proteomic profiles are associated with the pathology, mortality and lung sequelae.

[Comprehensive care in type 2 diabetes: from DiabeIMSS to CADIMSS]

In diabetes, obtaining optimal control is key to reducing chronic complications. Unfortunately, not all patients achieve the recommended goals. Therefore, the challenges to develop and evaluate comprehensive care models are enormous. In October 2008, the Diabetic Patient Care Program (DiabetIMSS) was designed and implemented in family medicine. Its principal component is the multidisciplinary team (doctor, nurse, psychologist, dietitian, dentist, and social worker) that offers coordinated health care;monthly medical consultation and individual, family and group education on self-care and prevention of complications for 12 months. Due to the COVID-19 pandemic, the percentage of attendance at the DiabetIMSS modules decreased significantly. This is how the Medical Director considered it necessary to strengthen them, and the Diabetes Care Centers (CADIMSS) arose. In addition to providing medical care with a comprehensive and multidisciplinary approach, the CADIMSS encourages the co-responsibility of the patient and his family. It consists of monthly medical consultation and nursing staff provides monthly educational sessions for 6 months. Pending tasks remain and there are still areas of opportunity to modernize and reorganize services that contribute to improving the health of the population with diabetes. Copyright © 2023 Revista Medica del Instituto Mexicano del Seguro Social.

Proteomic profiling of severe lung diffusion impairment in the recovery stage of COVID-19-induced ARDS

Background: Around 80% of patients who developed COVID-19-driven ARDS present lung ailment. There is a lack of knowledge of the mechanisms that mediate the pulmonary outcomes. Aim(s): To characterize the factors linked to diffusion impairment in survivors of severe COVID-19. Method(s): Prospective cohort study including 87 COVID-19-induced ARDS survivors. A complete pulmonary evaluation was performed 3 months after hospital discharge. 364 proteins were quantified using the proximity extension assay (PEA). Partial least square-discriminant analysis (PLS-DA) and random forest (RF) were used for multivariable analyses. Result(s): Moderate to severe diffusion impairment (DLCO<60% predicted) was observed in the 30% of the cohort. 15 proteins were differentially detected [false discovery rate (FDR)<0.05] in the univariate analysis. Pleiotrophin showed the highest differences (fold change=2.22 and FDR=0.001). In continuous analysis, proteins were inversely and independently associated with DLCO, and in some cases showed a robust dose-response relationship. PLS-DA and RF identified proteomic profiles related to the severity of diffusion capacity. Clusters identified were enriched in mediators of cell proliferation and differentiation, tissue remodeling, angiogenesis, coagulation, inflammation, immune response and fibrosis. Proteins are expressed in immune and non-immune lung cells. Conclusion(s): In survivors of COVID-19-driven ARDS, lung dysfunction is linked to plasma factors involved in injury and repair mechanisms. The host proteomic profile provides a novel understanding of post-acute sequelae and may be source of therapeutic strategies and biomarkers.

Improving social justice in observational studies: protocol for the development of a global and Indigenous STROBE-equity reporting guideline.

BACKGROUND: Addressing persistent and pervasive health inequities is a global moral imperative, which has been highlighted and magnified by the societal and health impacts of the COVID-19 pandemic. Observational studies can aid our understanding of the impact of health and structural oppression based on the intersection of gender, race, ethnicity, age and other factors, as they frequently collect this data. However, the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guideline, does not provide guidance related to reporting of health equity. The goal of this project is to develop a STROBE-Equity reporting guideline extension. METHODS: We assembled a diverse team across multiple domains, including gender, age, ethnicity, Indigenous background, disciplines, geographies, lived experience of health inequity and decision-making organizations. Using an inclusive, integrated knowledge translation approach, we will implement a five-phase plan which will include: (1) assessing the reporting of health equity in published observational studies, (2) seeking wide international feedback on items to improve reporting of health equity, (3) establishing consensus amongst knowledge users and researchers, (4) evaluating in partnership with Indigenous contributors the relevance to Indigenous peoples who have globally experienced the oppressive legacy of colonization, and (5) widely disseminating and seeking endorsement from relevant knowledge users. We will seek input from external collaborators using social media, mailing lists and other communication channels. DISCUSSION: Achieving global imperatives such as the Sustainable Development Goals (e.g., SDG 10 Reduced inequalities, SDG 3 Good health and wellbeing) requires advancing health equity in research. The implementation of the STROBE-Equity guidelines will enable a better awareness and understanding of health inequities through better reporting. We will broadly disseminate the reporting guideline with tools to enable adoption and use by journal editors, authors, and funding agencies, using diverse strategies tailored to specific audiences.

'I'm doing it for myself': Using a smartphone-based exercise service during the COVID-19 lockdown in the Faculty of Health Sciences, University of the Witwatersrand, South Africa.

Background: Sufficient physical activity (PA) lowers poor health outcomes, with data showing these protective effects in populations under varying levels of lockdown during the COVID-19 pandemic. The advent of online PA programmes has created novel opportunities to offset the deleterious effects of inactivity. However, data are limited and the readiness and acceptance of such technology is unknown. These authors nevertheless noted an opportunity to investigate this approach based on promising emerging data at the time of the hard lockdown in South Africa. Objective: This exploratory study investigated the engagement and perceptions of a smartphone application to promote health and fitness in a sample of employees at a South African university. Methods: Employed members of staff (n=15) of the University of the Witwatersrand were recruited through email invitation during the hard Level 5 COVID-19 lockdown in 2020. Individualised home-based PA programmes were prescribed through a mobile application for a period of eight weeks. Researchers qualified in Biokinetics provided online supervision of the exercise sessions during the intervention. Participants were asked to complete a self-reported questionnaire about their use of the application. Thematic analysis was used to understand these responses. Results: Lack of motivation was perceived to have a negative effect on participation in the online PA programme. Only one participant reported using the mobile application consistently during the study period, while half of the participants reported having trouble with the usage of the application. The participants frequently mentioned the need for technical support and further engagement from the clinicians supervising the PA programme to ensure use and progression. Staff identified issues with connectivity and already having too many phone applications (apps) amongst the reasons for the technical difficulties. Conclusion: This study demonstrates the challenges and potential for the uptake of online PA interventions during COVID-19 and, despite its small sample size, the data provide important lessons learned that will be used as information in further investigations.

Estimated impact of the COVID-19 pandemic on the prevalence and treatment of depressive symptoms in Peru: an interrupted time series analysis in 2014-2021.

PURPOSE: The COVID-19 pandemic increased the burden of mental disorders worldwide. Peru has been one of the countries most affected by COVID-19, however, studies evaluating the medium and long-term consequences of the pandemic on Peruvians' mental health are recent and represent a new field of study in proliferation. We aimed to estimate the impact of the COVID-19 pandemic on the prevalence and treatment of depressive symptoms using nationally representative surveys in Peru. METHODS: Our study is an analysis of secondary data. We carried out a time series cross-sectional analysis based on the National Demographic and Health Survey of Peru, collected using a complex sampling design. The Patient Health Questionnaire-9 was used to measure mild (5-9 points), moderate (10-14 points), and severe (15 points or more) depressive symptoms. The participants were men and women aged 15 years and older, living in urban and rural areas of all regions of Peru. The main statistical analysis used segmented regression with Newey-West standard errors, taking into account that each year of the evaluation was divided into four measures (quarter measure). RESULTS: We included 259,516 participants. An average quarterly increase of 0.17% (95% CI 0.03-0.32%) in the prevalence of moderate depressive symptoms was identified after the onset of the COVID-19 pandemic (approximately an increase of 1583 new cases of moderate depressive symptoms by each quarter). The percentage of cases treated for mild depressive symptoms increased quarterly by an average of 0.46% (95% CI 0.20-0.71%) after the onset of the COVID-19 pandemic (approximately an increase of 1242 new cases treated for mild depressive symptoms by each quarter). CONCLUSION: In Peru, increases in the prevalence of moderate depressive symptoms and the proportion of cases treated with mild depressive symptoms were found after the COVID-19 pandemic. Therefore, this study is a precedent for future research assessing the prevalence of depressive symptoms and the proportion of cases receiving treatment during the pandemic and post-pandemic years.

Assessment of Argentina’s Creditworthiness After the Debt Restructuring

Argentina’s 2020 debt restructuring was the second largest sovereign restructuring in history, after Greece’s in 2012. The sovereign’s latest default was triggered by extending maturities on short-term debt in August 2019, followed by another postponement of short-term debt payments in December 2019 and long-term debt payments in February 2020. In August 2019, the government also announced its intention to restructure its long-term debt. This article compares Argentina’s sovereign debt crisis with prior sovereign bond defaults and sets forth Moody’s view that significant challenges result in Argentina’s creditworthiness remaining weak even after the debt restructuring and despite sizeable losses for investors. These challenges include Argentina’s large share of foreign-currency debt amid its dependence on external foreign-exchange financing and limited domestic funding options, and subdued economic prospects as the coronavirus pandemic deepened the country’s multi-year recession and also affected Argentina’s main trading partners. © Multinational Finance Society, a nonprofit corporation. All rights reserved.

Evaluation of Customized Peripheral Sealing Device Acceptance for Surgical/Medical Masks Among Dental Professionals during Early COVID-19 Pandemic

A 3-dimensional (3D) printed custom-frame can improve the peripheral seal of readily available surgical/medical masks. This study aimed to assess the acceptance of a 3D-printed custom-frame with the American Society for Testing and Materials (ASTM) surgical/medical masks and the use of a face shield. A total of 206 subjects from a dental school participated, who answered a multiple-choice questionnaire. Participants received an invitation through the institutional email of the school via Qualtrics platform. 3D printed custom-frames were fabricated for each participant. According to their response, participants were divided into 4 groups: mask only (M), mask and frame (MF), mask and face shield (MFS), and all 3 personal protective equipment (MFFS). Data was analyzed in absolute and relative frequency. The acceptance of a 3D-printed custom-frame in the group MFFS varied between “poor”/’’very poor” (44.7%). It allowed “good” performance of routine procedures (40.3%), but “poor” visual quality (48.1%). Musculoskeletal tolerance and ease to perform movements were adequate. There was no interference in olfactory sensitivity (44.7%) or in the ability to breathe (34.5%). Finally, it showed "moderate pain" (48.1%) on the ear and "no pain" (38.9%) on the head. The 3D-printed custom-frame adapted to ASTM surgical/medical face masks showed reasonable tolerance. Side effects of ear pain ranging in degrees were noted. Further research is indicated to evaluate safety, comfort, compliance, side effects, and occupational hazards of long-term use of enhanced PPE recommendations.Avoiding the recurrent outbreaks of COVID-19, the use of PPE by the public is necessary. Improper PPE use is a major source of concern for human and environmental health. Preventing such activities can be done by following steps involved in PPE disposals or by getting a new way to re-use such as improving peripherical sealing. Our work highlights that a custom-frame can improve protection, without adverse effects. © 2022, Universidad de Costa Rica. All rights reserved.

Economic-environmental impacts on reduction of energy consumption in technical high schools during the COVID-19 pandemic: case of Manzanillo, Mexico

A study is presented on the economic and environmental impacts, due to the reduction of electricity consumption in a Technical High School in Manzanillo, Mexico, during the COVID-19 pandemic, as well as the impacts generated by the reduction of student mobility. This research shows an analysis of the reduction of electrical energy consumption, the reduction of monthly economic costs and CO2 emissions in the studied institution, these impacts on student mobility during confinement between November 2019 and October 2021 are also analyzed. Results show electrical energy savings of approximately 60MWh during this period, about 34 TnCO2 and an economic saving of 8654 USD. It has also estimated an economic saving in student mobility of approximately 312,840 USD and a reduction in emissions of the order of 64 TnCO2. This research also suggests the implementation of technologies that use renewable energy sources as a strategy in the face of this health emergency and contributes to raising future scenarios for sustainable energy planning.

Architectures of analytics intelligent decision technologies systems (IDTS) for the COVID-19 pandemic

This article presents a selective literature review of Analytics Intelligent Decision Technologies Systems (Analytics IDTS) developed to support decision-making in business and public organizations, with a particular focus on the global COVID-19 pandemic. We select Analytics IDTS published in 2019-2020 and evaluate them with an Analytics IDTS Design and Evaluation Framework. We include the types of Analytics IDTS, their decisional services, architectural capabilities, and support for phases in the decision-making process. Results are shown for 33 articles in the general Analytics domain and 71 articles in the focused Public Health domain applied to COVID-19, including how these Analytics IDTS were architected and utilized for decision making. Research in descriptive and predictive models is evident in Public Health COVID-19 research reflecting the lak of knowledge about the disease, while predictive and prescriptive models are the primary focus of the general Analytics domain. IDTS in all disciplines rely on Algorithmic decision services and Heuristic Analysis services. Higher-level decisional Synthesis and Hybrid services such as design, explanations, discovery, and learning associated with human decision-making are missing in most types of decision support, indicating that research in Machine Learning and AI has many growth opportunities for future research.

THE PERMANENCE IN HIGH SCHOOL IN VIRTUAL ENVIRONMENT: AN ANALYSIS OF THE PEDAGOGICAL STRATEGIES ADOPTED IN THE CONTEXT OF PANDEMIC OF THE COVID-19

The study emphasizes the impact of digital technological mediation on the permanence of high school students from the analysis of the pedagogical strategies adopted by Secretaria de Estado de Educacao e Desporto do Amazonas (SEDUC/AM), in the period of no presential classes, due to the Covid-19 pandemic, and in face of the gradual returning to the presential classes. It results from a survey of SEDUC's official documents, emphasizing the Home Lesson Project (remote education) and the Return to Classroom Plan (hybrid education). After analysis, it is considered that the Amazonas State has presented innovative initiatives in offering educational content. However, data points that about 45.85% of the high school students were without access to no presential classes. It evidences that if the democratization of technological resources to students isn't considered or if it is dissociated from the practice of remote education, it will happen an expansion of the problems that we already experience in the presential classes in public school.

Development of a Framework for the Implementation of Synchronous Digital Mental Health: Realist Synthesis of Systematic Reviews.

BACKGROUND: The use of technologies has served to reduce gaps in access to treatment, and digital health interventions show promise in the care of mental health problems. However, to understand what and how these interventions work, it is imperative to document the aspects related to their challenging implementation. OBJECTIVE: The aim of this study was to determine what evidence is available for synchronous digital mental health implementation and to develop a framework, informed by a realist review, to explain what makes digital mental health interventions work for people with mental health problems. METHODS: The SPIDER (Sample, Phenomenon of Interest, Design, Evaluation, and Research type) framework was used to develop the following review question: What makes digital mental health interventions with a synchronous component work on people with mental health problems, including depression, anxiety, or stress, based on implementation, economic, quantitative, qualitative, and mixed methods studies? The MEDLINE, EBM Reviews, PsycINFO, EMBASE, SCOPUS, CINAHL Complete, and Web of Science databases were searched from January 1, 2015, to September 2020 with no language restriction. A Measurement Tool to Assess Systematic Reviews-2 (AMSTAR-2) was used to assess the risk of bias and Confidence in Evidence from Reviews of Qualitative Research (CERQual) was used to assess the confidence in cumulative evidence. Realist synthesis analysis allowed for developing a framework on the implementation of synchronous digital mental health using a grounded-theory approach with an emergent approach. RESULTS: A total of 21 systematic reviews were included in the study. Among these, 90% (n=19) presented a critically low confidence level as assessed with AMSTAR-2. The realist synthesis allowed for the development of three hypotheses to identify the context and mechanisms in which these interventions achieve these outcomes: (1) these interventions reach populations otherwise unable to have access because they do not require the physical presence of the therapist nor the patient, thereby tackling geographic barriers posed by in-person therapy; (2) these interventions reach populations otherwise unable to have access because they can be successfully delivered by nonspecialists, which makes them more cost-effective to implement in health services; and (3) these interventions are acceptable and show good results in satisfaction because they require less need of disclosure and provide more privacy, comfortability, and participation, enabling the establishment of rapport with the therapist. CONCLUSIONS: We developed a framework with three hypotheses that explain what makes digital mental health interventions with a synchronous component work on people with mental health problems. Each hypothesis represents essential outcomes in the implementation process. TRIAL REGISTRATION: PROSPERO International Prospective Register of Systematic Reviews CRD42020203811; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020203811. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.12688/f1000research.27150.2.