[Prognostic scale for in-hospital mortality in patients with COVID-19 viral pneumonia]. / Escala pronóstica para mortalidad intrahospitalaria en pacientes con neumonía viral COVID-19.

Background: The COVID-19 pandemic represented a challenge in medical care. A tool would be very useful to establish the prognosis of in-hospital death that is reliable and can be applied to the Mexican population entitled to the IMSS. Objective: To propose a prognostic scale to stratify patients with viral pneumonia COVID-19 in the emergency services. Material and methods: A nested case-control study was conducted in a cohort of patients who were consecutively admitted to the emergency department with viral pneumonia COVID-19. The cases were those patients who died, and the controls were those who were discharged due to health improvement. An association analysis was performed between the variables with significant differences between groups. Subsequently, the association was adjusted using a multivariate logistic regression model, from which the prognostic scale was developed. Results: A total of 70 subjects with COVID-19 were included, 34 cases and 36 controls. Chronic diseases, smoking, severe pulmonary involvement diagnosed by tomography, leukocytosis, and pulse oximetry less than 80% with were associated with in-hospital mortality; Odds Ratio (OR) of >1.1. Vaccination was a protective factor (OR = 0.04, CI95%: 0.01-0.16). A score greater than 3 points on the prognostic scale predicts in-hospital mortality with a specificity of 0.86 and a sensitivity of 0.73. Conclusions: The proposed prognostic scale can be a useful tool in the classification of patients with COVID-19 viral pneumonia in the emergency room services of secondary care level Hospitals.

Introducción: la pandemia por COVID-19 representó un reto en la atención médica. Sería de gran utilidad una herramienta para establecer el pronóstico de muerte intrahospitalaria que sea confiable y pueda aplicarse a la población mexicana derechohabiente del Instituto Mexicano del Seguro Social. Objetivo: proponer una escala pronóstica para estratificar a los pacientes con neumonía viral por COVID-19 en los servicios de urgencias de los hospitales de segundo nivel. Material y métodos: se realizó un estudio de casos y controles anidado en una cohorte de pacientes adultos que fueron admitidos consecutivamente en el servicio de Urgencias con diagnóstico de neumonía viral por COVID-19. Los casos fueron aquellos pacientes que fallecieron y los controles aquellos que fueron egresados de la unidad por mejoría. Se realizó un análisis de asociación ente las variables con diferencias significativas entre ambos grupos, se ajustó la asociación mediante un modelo de regresión logística multivariada a partir del cual se elaboró la escala pronóstica. Resultados: se incluyeron en total 70 personas con COVID-19, 34 casos y 36 controles. Se asociaron a la mortalidad intrahospitalaria: las enfermedades crónicas, el tabaquismo, la afectación pulmonar severa diagnosticada por tomografía, la leucocitosis y la oximetría de pulso menor a 80% con una razón de Momios (RM) de > 1.1. La vacunación fue un factor protector (RM: 0.29, IC95%: 0.11-0.80). Un puntaje mayor a 3 puntos en la escala pronóstica predice la mortalidad intrahospitalaria (sensibilidad: 0.73, especificidad: 0.86). Conclusiones: la escala pronóstica propuesta puede ser una herramienta útil en la clasificación de los pacientes con neumonía viral por COVID-19 en los servicios de urgencias de los hospitales de segundo nivel de atención.

Replicating ¡Cuídate!: 6-Month Impact Findings of a Randomized Controlled Trial.

OBJECTIVES: To test whether ¡Cuídate!, a program culturally adapted for Hispanic youths, affects sexual risk behavior. METHODS: We evaluated 3 replications of ¡Cuídate! in California, Arizona, and Massachusetts in a randomized controlled trial (registry no. NCT02540304) in which 2169 primarily Hispanic participants were randomly assigned to an intervention (n = 1326) or a control (n = 870) group. Youths were surveyed at baseline (September 2012-April 2014) and 6 months postbaseline (March 2013-October 2014). We estimated pooled and subgroup impacts using a regression framework with baseline covariates to increase statistical precision (1216 youths analyzed in the treatment group, 806 analyzed in the control group). RESULTS: We found no impacts on the study's primary outcomes of recent sexual activity or recent unprotected sexual activity. However, ¡Cuídate! improved knowledge (10%-20% increase; P < .001), attitudes (effect size = .24; P < .001), and skills (effect size = .14; P = .002). Exploratory subgroup analyses suggest potentially problematic effects for some groups. CONCLUSIONS: Findings suggest that ¡Cuídate! was effective in improving youths' knowledge and attitudes. However, after 6 months, these changes did not translate to improvements in reported sexual risk behaviors.

Perceptions and Motivations to Prevent Heart Disease among Puerto Ricans.

OBJECTIVES: We performed a qualitative assessment of Puerto Ricans' knowledge and perceptions of cardiovascular disease (CVD), and motivations/barriers and preferences to participate in community/ clinical programs for CVD-prevention. METHODS: Four guided focus group discussions were conducted on a total of 24 Puerto Ricans, aged 40-60 years in Boston, MA. RESULTS: Participants were aware of CVD, but less knowledgeable about its prevention. They perceived it as serious, and either had CVD or knew someone who had it. They favored education and activities on nutrition, exercise, clinical advice, and social interaction, in weekly/ biweekly small-group sessions with other Latinos, led in Spanish by a familiar health professional, in a convenient community location. Age- and culture-specific program content and educational materials were preferred. A theme emerged on 'personal or family motivations' such as to become healthier and live longer so they would feel better and support their families, or to learn about CVD-prevention. Main barriers included family obligations, weather, safety concerns, transportation, and depressive mood. CONCLUSIONS: Culturally-tailored CVD-prevention programs for Puerto Ricans should include multiple behavioral and social approaches, and draw on intrinsic motivators while reducing barriers to help enhance efficacy and sustainability.

Life cycle comparison of waste-to-energy alternatives for municipal waste treatment in Chilean Patagonia.

The energy system in the Region of Aysén, Chile, is characterized by a strong dependence on fossil fuels, which account for up to 51% of the installed capacity. Although the implementation of waste-to-energy concepts in municipal waste management systems could support the establishment of a more fossil-independent energy system for the region, previous studies have concluded that energy recovery systems are not suitable from an economic perspective in Chile. Therefore, this work intends to evaluate these technical options from an environmental perspective, using life cycle assessment as a tool for a comparative analysis, considering Coyhaique city as a case study. Three technical alternatives were evaluated: (i) landfill gas recovery and flaring without energy recovery; (ii) landfill gas recovery and energy use; and (iii) the implementation of an anaerobic digestion system for the organic waste fraction coupled with energy recovery from the biogas produced. Mass and energy balances of the three analyzed alternatives have been modeled. The comparative LCA considered global warming potential, abiotic depletion and ozone layer depletion as impact categories, as well as required raw energy and produced energy as comparative regional-specific indicators. According to the results, the use of the recovered landfill gas as an energy source can be identified as the most environmentally appropriate solution for Coyhaique, especially when taking into consideration the global impact categories.

Collaboration across eight research centers: unanticipated benefits and outcomes for project managers.

Managers of transdisciplinary collaborative research lack suitable didactic material to support the implementation of research methodologies and to build ongoing partnerships with community representatives and peers, both between and within multiple academic centers. This article will provide insight on the collaborative efforts of project managers involved in multidisciplinary research and their subsequent development of a tool kit for research project managers and/or directors. Project managers from the 8 Centers for Population Health and Health Disparities across the nation participated in monthly teleconferences to share experiences and offer advice on how to achieve high participation rates and maintain community involvement in collaboration with researchers and community leaders to achieve the common goal of decreasing health inequities. In the process, managers recognized and seized the opportunity to produce a tool kit that was designed for future project managers and directors. Project managers in geographically distinct locations maintained a commitment to work together over 4 years and subsequently built upon an existing communications network to design a tool kit that could be disseminated easily to a diverse audience.