Towards the Future of Public Health: Roadmapping Trends and Scenarios in the Post-COVID Healthcare Era.

The COVID-19 pandemic, a transformative event in modern society, has disrupted routine, work, behavior, and human relationships. Organizations, amidst the chaos, have innovatively adapted to the evolving situation. However, many countries were unprepared for the magnitude of the challenge, revealing the fragility of health responses due to inadequate leadership, insufficient resources, and poor information system integration. Structural changes in health systems are imperative, particularly in leadership, governance, human resources, financing, information systems, technology, and health service provision. This research utilizes the Technological Roadmapping method to analyze the health sector, focusing on public health, drawing on articles from SCOPUS and PubMed databases, and creating a roadmap extending to 2050. The research presents three long-term scenarios based on the literature-derived roadmap and explores various alternatives, including integrated care, telemedicine, Big Data utilization, nanotechnology, and Big Tech's AI services. The results underscore the anticipation of post-pandemic public health with high expectations, emphasizing the importance of integrating health history access, encouraging self-care, and leveraging technology for streamlined treatment. Practical implications include insights for decision makers and stakeholders to inform strategic planning and adapt to evolving industry demands, recognizing the significance of preventive services and the humanizing potential of technology.

Development of an Index for the Inspection of Aedes aegypti Breeding Sites in Brazil: Multi-criteria Analysis.

BACKGROUND: Aedes aegypti is a vector for the transmission of diseases such as dengue fever, chikungunya, Zika fever, and yellow fever. In 2016, over 1 million cases of these diseases were reported in Brazil, which is an alarming public health issue. One of the ways of controlling this disease is by inspecting and neutralizing the places where A. aegypti lays its eggs. The Ministry of Planning, Development, and Administration of Brazil maintains the inspection statistics. OBJECTIVE: We propose a multi-criteria analysis to create an index for A. aegypti inspections reported through the Ministry of Planning, Development, and Administration system of Brazil. METHODS: Based on the repository from urban cleaning services combined with data on inspections conducted by government agencies in several Brazilian cities and municipalities, we selected and combined metrics, which we further ranked using the analytic hierarchy process methodology. We also developed risk maps based on the analytic hierarchy process ranking of the A. aegypti breeding sites. RESULTS: Based on our analysis and the available data, the priority for inspections should consider the number of sick people (weight 0.350), medical evaluations (weight 0.239), inspections (weight 0.201), mosquito breeding sites (weight 0.126), and days of absence from work (weight 0.096). CONCLUSIONS: The proposed index could aid public health practitioners in preventing the appearance of new A. aegypti breeding sites. This information technology application can help solve such public health challenges.

Internet of Everything (IoE) Taxonomies: A Survey and a Novel Knowledge-Based Taxonomy.

The paradigm of the Internet of everything (IoE) is advancing toward enriching people's lives by adding value to the Internet of things (IoT), with connections among people, processes, data, and things. This paper provides a survey of the literature on IoE research, highlighting concerns in terms of intelligence services and knowledge creation. The significant contributions of this study are as follows: (1) a systematic literature review of IoE taxonomies (including IoT); (2) development of a taxonomy to guide the identification of critical knowledge in IoE applications, an in-depth classification of IoE enablers (sensors and actuators); (3) validation of the defined taxonomy with 50 IoE applications; and (4) identification of issues and challenges in existing IoE applications (using the defined taxonomy) with regard to insights about knowledge processes. To the best of our knowledge, and taking into consideration the 76 other taxonomies compared, this present work represents the most comprehensive taxonomy that provides the orchestration of intelligence in network connections concerning knowledge processes, type of IoE enablers, observation characteristics, and technological capabilities in IoE applications.

Amyotrophic Lateral Sclerosis: New Perpectives and Update.

Amyotrophic lateral sclerosis (ALS), Charcot's disease or Lou Gehrig's disease, is a term used to cover the spetrum of syndromes caracterized by progressive degeneration of motor neurons, a paralytic disorder caused by motor neuron degeneration. Currently, there are approximately 25,000 patients with ALS in the USA, with an average age of onset of 55 years. The incidence and prevalence of ALS are 1-2 and 4-6 per 100,000 each year, respectively, with a lifetime ALS risk of 1/600 to 1/1000. It causes progressive and cumulative physical disabilities, and leads to eventual death due to respiratory muscle failure. ALS is diverse in its presentation, course, and progression. We do not yet fully understand the causes of the disease, nor the mechanisms for its progression; thus, we lack effective means for treating this disease. In this chapter, we will discuss the diagnosis, treatment, and how to cope with impaired function and end of life based on of our experience, guidelines, and clinical trials. Nowadays ALS seems to be a more complex disease than it did two decades - or even one decade - ago, but new insights have been plentiful. Clinical trials should be seen more as experiments on pathogenic mechanisms. A medication or combination of medications that targets more than one pathogenic pathway may slow disease progression in an additive or synergistic fashion.

Botulinum Neurotoxin Type A in Neurology: Update.

This paper reviews the current and most neurological (central nervous system, CNS) uses of the botulinum neurotoxin type A. The effect of these toxins at neuromuscular junction lends themselves to neurological diseases of muscle overactivity, particularly abnormalities of muscle control. There are seven serotypes of the toxin, each with a specific activity at the molecular level. Currently, serotypes A (in two preparations) and B are available for clinical purpose, and they have proved to be safe and effective for the treatment of dystonia, spasticity, headache, and other CNS disorders in which muscle hyperactivity gives rise to symptoms. Although initially thought to inhibit acetylcholine release only at the neuromuscular junction, botulinum toxins are now recognized to inhibit acetylcholine release at autonomic cholinergic nerve terminals, as well as peripheral release of neuro-transmitters involved in pain regulation. Its effects are transient and nondestructive, and largely limited to the area in which it is administered. These effects are also graded according to the dose, allowing individualized treatment of patients and disorders. It may also prove to be useful in the control of autonomic dysfunction and sialorrhea. In over 20 years of use in humans, botulinum toxin has accumulated a considerable safety record, and in many cases represents relief for thousands of patients unaided by other therapy.

Enhancing knowledge flow in a health care context: a mobile computing approach.

BACKGROUND: Advances in mobile computing and wireless communication have allowed people to interact and exchange knowledge almost anywhere. These technologies support Medicine 2.0, where the health knowledge flows among all involved people (eg, patients, caregivers, doctors, and patients' relatives). OBJECTIVE: Our paper proposes a knowledge-sharing environment that takes advantage of mobile computing and contextual information to support knowledge sharing among participants within a health care community (ie, from patients to health professionals). This software environment enables knowledge exchange using peer-to-peer (P2P) mobile networks based on users' profiles, and it facilitates face-to-face interactions among people with similar health interests, needs, or goals. METHODS: First, we reviewed and analyzed relevant scientific articles and software apps to determine the current state of knowledge flow within health care. Although no proposal was capable of addressing every aspect in the Medicine 2.0 paradigm, a list of requirements was compiled. Using this requirement list and our previous works, a knowledge-sharing environment was created integrating Mobile Exchange of Knowledge (MEK) and the Easy to Deploy Indoor Positioning System (EDIPS), and a twofold qualitative evaluation was performed. Second, we analyzed the efficiency and reliability of the knowledge that the integrated MEK-EDIPS tool provided to users according to their interest topics, and then performed a proof of concept with health professionals to determine the feasibility and usefulness of using this solution in a real-world scenario. RESULTS: . Using MEK, we reached 100% precision and 80% recall in the exchange of files within the peer-to-peer network. The mechanism that facilitated face-to-face interactions was evaluated by the difference between the location indicated by the EDIPS tool and the actual location of the people involved in the knowledge exchange. The average distance error was <6.28 m for an indoor environment. The usability and usefulness of this tool was assessed by questioning a sample of 18 health professionals: 94% (17/18) agreed the integrated MEK-EDIPS tool provides greater interaction among all the participants (eg, patients, caregivers, doctors, and patients' relatives), most considered it extremely important in the health scenario, 72% (13/18) believed it could increase the knowledge flow in a health environment, and 67% (12/18) recommend it or would like to recommend its use. CONCLUSIONS: The integrated MEK-EDIPS tool can provide more services than any other software tool analyzed in this paper. The proposed integrated MEK-EDIPS tool seems to be the best alternative for supporting health knowledge flow within the Medicine 2.0 paradigm.

Another Perspective on Fasciculations: When is it not Caused by the Classic form of Amyotrophic Lateral Sclerosis or Progressive Spinal Atrophy?

Fasciculations are visible, fine and fast, sometimes vermicular contractions of fine muscle fibers that occur spontaneously and intermittently. The aim of this article is to discuss the main causes for fasciculations and their pathophysiology in different sites of the central/peripheral injury and in particular to disprove that the presence of this finding in the neurological examination is indicative of amyotrophic lateral sclerosis. Undoubtedly, most fasciculations have a distal origin in the motor nerve both in normal subjects and in patients with motor neuron disease. Most of them spread to other dendritic spines often producing an antidromic impulse in the main axon. The clinical and neurophysiological diagnosis must be thorough. It may often take long to record fasciculations with electroneuromyography. In other cases, temporal monitoring is necessary before the diagnosis. The treatment, which may be adequate in some cases, is not always necessary.

Lower mortality rate in people with dementia is associated with better cognitive and functional performance in an outpatient cohort.

UNLABELLED: We describe a three-year experience with patients with dementia. METHOD: clinical, cognitive and functional evaluation was performed by a multidisciplinary team for persons above 60 years. Mortality was assessed after three years. RESULTS: Mini-Mental State Examination (MMSE) (n=2,074) was 15.7 (8.4). Male patients MMSE (n=758) was 15.6 (8.3) and female's (n=1315) was 15.8 (8.3). Instrumental Activities of Daily Living Scale (n=2023) was 16.5 (7.6); females (n=1277) was 16.9 (7.2) and males (n=745) was 15.7(8.2). From these patients, 12.6% (n=209) died within three years. Baseline cognition of patients still alive was higher (p<0.001) than MMSE of those who died [MMSE=16.3 (8.1) vs. 10.6 (7.6)]. Mortality rate decreased 6% (IR=0.94) for each additional point on MMSE. Higher functional status decreases the mortality rate approximately 11% (IR=0.89) independently of age, gender, and education. CONCLUSION: Three-year mortality rates are dependent on baseline functional and cognitive status.

Ankle-brachial index, a screening for peripheral obstructive arterial disease, and migraine - a controlled study.

BACKGROUND: Epidemiological studies support the association between migraine, especially migraine with aura, and vascular disorders. The ankle-brachial index (ABI) is largely used as a surrogate of peripheral obstructive arterial disorders (POAD). Accordingly, in this study we contrasted the ABI in individuals with migraine and in controls. METHODS: We investigated 50 migraineurs and 38 controls and obtained the ABI (ratio between the systolic arterial pressure obtained in the legs and in the arms) using digital sphygmomanometry. As per validation studies, we used the cut-off of 0.9 as the normal limit for the ABI. We adjusted for gender, use of contraceptive hormones, tabagism, and other cardiovascular risk factors. RESULTS: We found abnormal values of ABI, suggestive of mild or moderate POAD, in 31 individuals (35.2%). Mean value was 0.96 (standard deviation = 0.10). None of our patients had ABI < 0.4, which would suggest severe POAD. Mean ABI for migraineurs was 0.94 (0.11), and for controls it was 0.99 (0.09). Difference was significant (t = 2.21 and P = .022). After adjustments, ABI remained significantly associated with migraine status (P = .024). Adjustments were reasonably effective (chi(2) of Hosmer-Lemeshow = 1.06, P = .590). CONCLUSION: Our findings suggest that decreased values of ABI are more common in migraineurs than in controls. Although causality was not assessed by us, the relationship is of importance per se. Doctors should measure the ABI in individuals with migraine as an easy way to screen for cardiovascular risk.