Simulation of pandemics in real cities: enhanced and accurate digital laboratories.

This study develops a modelling framework for simulating the spread of infectious diseases within real cities. Digital copies of Birmingham (UK) and Bogotá (Colombia) are generated, reproducing their urban environment, infrastructure and population. The digital inhabitants have the same statistical features of the real population. Their motion is a combination of predictable trips (commute to work, school, etc.) and random walks (shopping, leisure, etc.). Millions of individuals, their encounters and the spread of the disease are simulated by means of high-performance computing and massively parallel algorithms for several months and a time resolution of 1 minute. Simulations accurately reproduce the COVID-19 data for Birmingham and Bogotá both before and during the lockdown. The model has only one adjustable parameter calculable in the early stages of the pandemic. Policymakers can use our digital cities as virtual laboratories for testing, predicting and comparing the effects of policies aimed at containing epidemics.

Conceptual framework of equity-focused implementation research for health programs (EquIR).

BACKGROUND: Implementation research is increasingly used to identify common implementation problems and key barriers and facilitators influencing efficient access to health interventions. OBJECTIVE: To develop and propose an equity-based framework for Implementation Research (EquIR) of health programs, policies and systems. METHODS: A systematic search of models and conceptual frameworks involving equity in the implementation of health programs, policies and systems was conducted in Medline (PubMed), Embase, LILACS, Scopus and grey literature. Key characteristics of models and conceptual frameworks were summarized. We identified key aspects of equity in the context of seven Latin American countries-focused health programs We gathered information related to the awareness of inequalities in health policy, systems and programs, the potential negative impact of increasing inequalities in disadvantaged populations, and the strategies used to reduce them. RESULTS: A conceptual framework of EquIR was developed. It includes elements of equity-focused implementation research, but it also links the population health status before and after the implementation, including relevant aspects of health equity before, during and after the implementation. Additionally, health sectors were included, linked with social determinants of health through the "health in all policies" proposal affecting universal health and the potential impact of the public health and public policies. CONCLUSION: EquIR is a conceptual framework that is proposed for use by decision makers and researchers during the implementation of programs, policies or health interventions, with a focus on equity, which aims to reduce or prevent the increase of existing inequalities during implementation.

[Construction and validation of a model to predict intraoperative hypothermia]. / Construcción y validación de un modelo predictivo de hipotermia intraoperatoria.

OBJECTIVES: Perioperative hypothermia is linked to adverse effects that increase morbidity and mortality. The objectives of this study were to identify the risk factors for intraoperative hypothermia and construct an instrument for identifying patients at high risk. MATERIALS AND METHODS: We studied patients of all ages who had undergone surgery. Patients were assigned to a design group or a validation group by means of a list of randomly generated numbers. Intraoperative hypothermia was defined by an tympanic temperature of 35.9 degrees C or less. A bivariate analysis of the design group identified the predictive factors and a multivariate analysis (logistic regression with backward elimination of nonsignificant variables) provided a predictive model. Risk scores were obtained for each variable by converting them to a 4-degree risk scale (abbreviated model). Predictive power was determined by calculating the area under the receiver-operator characteristic curve (AUC). RESULTS: We enrolled 264 consecutive patients; 200 were assigned to the design group and 64 to the validation group. In the design group, the AUC was 0.85 for the complete model and 0.83 for the abbreviated model. In the validation group, the AUC was 0.85 for the complete model and 0.82 for the abbreviated model. The P value was <.01 for all curves. CONCLUSION: Age, weight, approximate duration of surgery, and body and ambient temperature during induction were the included factors that predicted intraoperative hypothermia in a heterogeneous sample of surgical patients.

Construcción y validación de un modelo predictivo de hipotermiaintraoperatoria / Construction and validation of a model to predict intraoperative hypothermia

OBJETIVO: La hipotermia perioperatoria se asocia aefectos adversos que aumentan la morbilidad y la mortalidad.El objetivo de este estudio fue identificar los factoresde riesgo para hipotermia intraoperatoria y construir unaherramienta para identificar a los pacientes de alto riesgo.MATERIAL Y MÉTODOS: Se estudiaron pacientes, sin límitede edad, en los que se realizó algún procedimiento quirúrgico.Fueron asignados a dos grupos “diseño” y “validación”mediante una lista de números generados al azar. Lahipotermia intraoperatoria se definió como una temperaturatimpánica de 35,9ºC o menos. En un análisis bivariableen el grupo diseño se identificaron los factores predictores ydespués en un modelo multivariable (regresión logística deeliminación progresiva de variables no significativas) seobtuvo un modelo predictivo. Además, se elaboró una tablade puntuación transformando las variables (modelo abreviado).El poder predictivo se determinó mediante el áreabajo la curva ROC [área bajo curva ROC (ABC-ROC)].RESULTADOS: Se incluyeron 264 pacientes consecutivos;200 en el grupo diseño y 64 en el de validación En el grupodiseño el ABC-ROC del modelo completo fue 0,85 y ladel modelo abreviado ABC-ROC 0,83. En el grupo validaciónel ABC-ROC del modelo competo fue 0,85 y la delmodelo abreviado ABC-ROC 0,82. El valor P fue <0,01 entodas las curvas.CONCLUSIÓN: En nuestro estudio, la edad, peso, duraciónestimada del procedimiento y las temperaturas corporaly ambiental durante la inducción, incluidas en unmodelo predictivo, fueron factores preoperatorios que predicenel desarrollo de hipotermia intraoperatoria en unamuestra heterogénea de pacientes quirúrgicos (AU)

OBJECTIVES: Perioperative hypothermia is linked toadverse effects that increase morbidity and mortality. Theobjectives of this study were to identify the risk factors forintraoperative hypothermia and construct an instrumentfor identifying patients at high risk.MATERIALS AND METHODS: We studied patients of allages who had undergone surgery. Patients were assignedto a design group or a validation group by means of a listof randomly generated numbers. Intraoperativehypothermia was defined by an tympanic temperature of35.9°C or less. A bivariate analysis of the design groupidentified the predictive factors and a multivariate analysis(logistic regression with backward elimination ofnonsignificant variables) provided a predictive model.Risk scores were obtained for each variable by convertingthem to a 4-degree risk scale (abbreviated model).Predictive power was determined by calculating the areaunder the receiver-operator characteristic curve (AUC).RESULTS: We enrolled 264 consecutive patients; 200were assigned to the design group and 64 to the validationgroup. In the design group, the AUC was 0.85 for thecomplete model and 0.83 for the abbreviated model. In thevalidation group, the AUC was 0.85 for the completemodel and 0.82 for the abbreviated model. The P valuewas <.01 for all curves.CONCLUSION: Age, weight, approximate duration ofsurgery, and body and ambient temperature duringinduction were the included factors that predictedintraoperative hypothermia in a heterogeneous sample ofsurgical patients (AU)

A new Inequity-in-Health Index based on Millennium Development Goals: methodology and validation.

OBJECTIVES: Developing a new Inequity-in-Health Index (IHI) assuming inequity as "inequality of health outcomes," based on Millennium Development Goals (MDG). STUDY DESIGN AND SETTING: Ecological study. Countries from around the world were included from United Nations, the World Bank, and a nonprofit organization's databases. The reliability and validity of this bidimensional IHI was tested. Main factor analysis (promax rotation) and main component analysis were used. RESULTS: Six variables were used for constructing the IHI was constructed with six variables: underweight children, child mortality, death from malaria in children aged 0-4, death from malaria at all ages, births attended by skilled health personnel, and immunization against measles. The IHI had high internal consistency (Cronbach's alpha=0.8504), was reliable (Spearman>0.9, P=0.0000), and had 0.3033pi around the world (range: 0pi-0.5984pi). IHI had high correlation with the human development and poverty indexes, health gap indicator, life expectancy at birth, probability of dying before 40 years of age, and Gini coefficients (Spearman>0.7, P=0.0000). IHI discriminated countries by income, region, indebtedness, and corruption level (Kruskal Wallis, P<0.01). IHI had sensitivity to change (P=0.0000). CONCLUSION: IHI is a bidimensional, valid and reliable index to monitor MDG. A new reliable methodology for developing bidimensional indicators is shown, which could be used for constructing other ones with their corresponding scores and graphs.

[Colombian validation of the Pittsburgh Sleep Quality Index]. / Validación colombiana del índice de calidad de sueño de Pittsburgh.

INTRODUCTION: Many studies establish an elevated frequency of sleep disorders. The prevalence during life is of 35%. This situation has lead to develop a great number of instruments with the intention to evaluate better these alterations. Nevertheless, the majority lacks a suitable and national validation. Buysse et al designed the Pittsburgh Sleep Quality Index (PSQI) considered the most able instrument to establish the quality of the sleep. This has been used and validated widely. Nor it exists a version validated to the Castilian for Colombia, nor similar instruments that allow making studies in sleep. AIM: Validation of the Pittsburg Sleep Quality Index in Colombia (ICSP-VC). SUBJECTS AND METHODS: Experts consensus for face validity, pilots studies for evaluating understanding of the questionnaire, with double interview method. Evaluation of internal consistency. RESULTS. Internal consistency was Cronbach's alpha = 0.78. There were different scores between subjects that mentioned some subjective sleep disturbance (U Mann Whitney z = -5.635, p = 0.000), between them that qualify as 'so bad' or not their sleep quality (U Mann Whitney z = -2.90, p = 0.0037), between they that were consuming or not, habitually hypnotics (U Mann Whitney z = -4.289, p = 0.0000) and between they that referred conciliation insomnia or not (U Mann Whitney z = -4.769, p = 0.0000). There were clinical differences in ICSP-VC scores between adult older and younger (U Mann Whitney z = -1.926, p = 0.0542). There were not differences by gender. Subjects with extreme values scores had clinical differences with others. CONCLUSIONS: ICSP-VC is a valid version of PQSI useful for studying sleep disorders.

Validación colombiana del índice de calidad de sueño de Pittsburgh / Colombian validation of the pittsburgh sleep quality index

Introducción. Muchos estudios establecen una frecuencia elevada de alteraciones del sueño. La prevalencia durante la vida es del 35%. Esta situación ha conducido a desarrollar un gran número de instrumentos con la intención de evaluar mejor estas alteraciones. Sin embargo, la mayoría carecen de una validación adecuada y nacional. Buysse et al diseñaron el índice de calidad de sueño de Pittsburgh (ICSP), considerado el instrumento más capaz para establecer la calidad del sueño. Éste ha sido ampliamente usado y validado, pero no existe una versión validada al castellano para Colombia, ni instrumentos similares que permitan realizar estudios sobre el sueño. Objetivo. Validar en Colombia el ICSP (ICSP-VC). Sujetos y métodos. Se emplearon consensos de expertos para la validación facial y estudios pilotos para evaluar la comprensión, mediante doble entrevista. Se evaluó la consistencia interna y se realizó una validación concurrente y discriminante. Resultados. La consistencia interna α de Cronbach fue 0,78. Hubo puntuaciones diferentes clínica y estadísticamente para los sujetos con alguna alteración del sueño (U de Mann Whitney: z = -5,635, p = 0,000), con ‘muy mala’ calidad de sueño o no (U de Mann Whitney: z = -2,90, p = 0,0037), con uso de hipnóticos o no (U de Mann Whitney: z = -4,289, p= 0,0000) y con insomnio de conciliación o no (U de Mann Whitney: z = -4,769, p = 0,0000). Se encontraron diferencias clínicas en las puntuaciones de ancianos comparados con jóvenes (U de Mann Whitney: z = -1,926, p = 0,0542). No hubo diferencias por sexo. Los sujetos con puntuaciones extremas tuvieron características clínicas diferentes, al compararlos con los que no se encontraban en estos valores. Conclusiones. El ICSP-VC es una versión valida del ICSP útil para estudiar trastornos del sueño

Introduction. Many studies establish an elevated frequency of sleep disorders. The prevalence during life is of 35%. This situation has lead to develop a great number of instruments with the intention to evaluate better these alterations. Nevertheless, the majority lacks a suitable and national validation. Buysse et al designed the Pittsburgh Sleep Quality Index (PSQI) considered the most able instrument to establish the quality of the sleep. This has been used and validated widely. Nor it exists a version validated to the Castilian for Colombia, nor similar instruments that allow making studies in sleep. Aim. Validation of the Pittsburg Sleep Quality Index in Colombia (ICSP-VC). Subjects and methods. Experts consensus for face validity, pilots studies for evaluating understanding of the questionnaire, with double interview method. Evaluation of internal consistency. Results. Internal consistency was Cronbach’s alpha = 0.78. There were different scores between subjects that mentioned some subjective sleep disturbance (U Mann Whitney z = -5.635, p = 0.000), between them that qualify as ‘so bad’ or not their sleep quality (U Mann Whitney z = -2.90, p = 0.0037), between they that were consuming or not, habitually hypnotics (U Mann Whitney z = -4.289, p = 0.0000) and between they that referred conciliation insomnia or not (U Mann Whitney z = -4.769, p = 0.0000). There were clinical differences in ICSP-VC scores between adult older and younger (U Mann Whitney z = -1.926, p = 0.0542). There were not differences by gender. Subjects with extreme values scores had clinical differences with others. Conclusions. ICSP-VC is a valid version of PQSI useful for studying sleep disorders

Improved method for comparative evaluation of aldosterone antagonists in healthy man.

A method of assessing the qualitative and quantitative activity of competitive aldosterone antagonists in healthy man is described. It requires intravenous infusion of aldosterone (0.5 mg/6 h), iv and oral water loading for six hours and fractionated collection of urine over eight hours. Aldosterone antagonists were administered orally 1.5 h before the start of the infusion (spironolactone 50, 200 or 800 mg) or added to the infused solution (potassium cnarenoate 300, 600 or 1000-1200 mg). The effect was assessed by changes in urinary sodium and potassium excretion and in urinary Na+/K+ ratio. The plasma levels and urinary excretion of canrenone, canrenoate and canrenoate ester glucuronide, respectively, were determined after administration of spironolactone and potassium canrenoate. Between 4-8 h (spironolactone) or 2-8 h (potassium canrenoate) after commencement of the infusion there was linear dose-dependent reversal of the mineralocorticoid-induced sodium retention and/or decrease in the Na+/K+ ratio. The plasma levels and urinary excretion of the metabolites measured were also dose-dependent. The method appears suitable for comparison of the potency of aldosterone antagonists and for defining the time course of drug action within the observation period employed.