Adoption of digital tools in the context of the COVID-19 pandemic in the Region of the Americas - the Go.Data experience.

The COVID-19 pandemic has accelerated the growth of digital health tools. Although a number of different tools exist to support field data collection in the context of outbreak response, they have not been sufficient. This prompted the World Health Organization (WHO) to collaborate with the Global Outbreak Alert and Response Network (GOARN) and GOARN partners to develop a comprehensive system, Go.Data. Go.Data, a digital tool for outbreak response has simplified how countries operationalize and monitor case and contact data. Since the start of the pandemic, WHO and GOARN partners have provided support to Go.Data projects in 65 countries and territories, yet the demand by countries to have documented success cases of Go.Data implementations continues to grow. This viewpoint documents the successful Go.Data implementation frameworks in two countries, Argentina and Guatemala and an academic institution, the University of Texas at Austin.

Effects of game-based interventions on functional capacity in acutely hospitalised older adults: results of an open-label non-randomised clinical trial.

BACKGROUND: Hospitalisation-associated disability due to reduced physical activity levels and prolonged bedrest episodes are highly prevalent in older adults. OBJECTIVE: To assess the effect of gamified interventions on functional capacity in hospitalised older adults. METHODS: A three-armed non-randomised controlled trial with two experimental intervention groups and a control group was conducted in a tertiary public hospital in Navarre, Spain. Participants were allocated to a simple gamification group (SGG) (n = 21), a technology-based gamification group (TGG) (n = 23) or a control group (CG) (n = 26). The end points were changes in functional capacity, muscle strength, cognition, mood status and quality of life. RESULTS: Seventy patients (mean age 86.01 ± 4.27 years old) were included in the study; 29 (41.4%) were women. At discharge, compared to CG, a mean increase of 1.47 points (95%CI, 0.15-2.80 points) and 2.69 points (95%CI, 1.32-4.06 points) was observed (SGG and TGG, respectively) in the SPPB test; as well as an increase of 5.28 points (95%CI, 0.70-9.76 points) in the Barthel Index and 2.03 kg (95%CI, 0.33-3.72 kg) in handgrip strength in the TGG. Regression mediation analyses demonstrated that muscle strength changes (ß = 1.30; 95%CI, 0.45-2.14; indirect effect 0.864; 95%CI, 0.09-1.90) significantly mediated the TGG effect on the SPPB score. CONCLUSIONS: The TGG intervention programme may provide significant benefits in physical and muscle function over usual care and seems to reverse the functional decline frequently associated with acute hospitalisation in older adults.

A Feasibility Study for Implementation "Health Arcade": A Study Protocol for Prototype of Multidomain Intervention Based on Gamification Technologies in Acutely Hospitalized Older Patients.

The aim of this article is to present the research protocol for a study that will evaluate the feasibility of implementation of Health Arcade prototype multidomain intervention based on physical and cognitive training using gamification technologies at improving care for older people hospitalized with an acute illness. A total of 40 older people will be recruited in a tertiary public hospital at Pamplona, Spain. The intervention duration will be four to nine consecutive days. Additionally, the patients will receive encouragement for maintaining active during hospital stay and for reducing sedentary time. Primary implementation-related outcomes will be the adherence to treatment (i.e., number of games and days completed during the intervention period), reaction or response time, and number of success and failures in each game per day. Secondary implementation-related outcomes will be self-perceived grade of difficulty, satisfaction, enjoyment per game and session, and self-perceived difficulties in handling the prototype hardware. Other health-related outcomes will also be assessed such as functional capacity in activities of daily living, mood status, quality of life, handgrip strength, physical activity levels, and mobility. The current study will provide additional evidence to support the implementation of multidomain interventions designed to target older persons with an acute illness based on friendly technology. The proposed intervention will increase accessibility of in-clinical geriatrics services, improve function, promote recovery of the health, and reduce economic costs.

Abordar la violencia contra las mujeres desde una perspectiva integral / Addressing violence against women from a holistic perspective

En los últimos veinte años, la violencia contra las mujeres ha estado presente en la agenda pública nacional e internacional. Los tratados internacionales, los desarrollos normativos locales y nacionales y el desarrollo de políticas públicas que tienen como centro una vida libre de violencia para las mujeres son ejemplo de estos avances. En estas décadas de trabajo se ha identificado la importancia de abordar este problema de forma integral. ¿Por qué? Porque las causas de la violencia contra la mujer son multifactoriales, las afectaciones trascienden la esfera física del golpe y porque la atención debe ser interdisciplinaria. Así mismo, las consecuencias de este tipo de violencia afectan a las mujeres en múltiples esferas. En Colombia, la Ley 1257 de 2008 reconoce la importancia de llevar a cabo acciones coordinadas entre las distintas entidades que hacen parte de los procesos de información, prevención, orientación, protección, sanción, reparación y estabilización de los derechos de las mujeres víctimas de violencia. Asimismo, establece medidas específicas en el ámbito laboral, familiar y de la salud.

In the last twenty years, violence against women has been on the national and international public agenda. International treaties, local and national regulatory developments and the development of public policies that focus on a life free of violence for women are examples of these advances. In these decades of work, the importance of addressing this problem in a comprehensive manner has been identified. Why? Because the causes of violence against women are multifactorial, the effects transcend the physical sphere of the blow and because the attention must be interdisciplinary. Likewise, the consequences of this type of violence affect women in multiple spheres. In Colombia, Law 1257 of 2008 recognizes the importance of carrying out coordinated actions among the different entities involved in the processes of information, prevention, orientation, protection, sanction, reparation and stabilization of the rights of women victims of violence. It also establishes specific measures in the labor, family and health areas.

Catastrophic outcome of patients with a rebound after Natalizumab treatment discontinuation.

INTRODUCTION: Natalizumab (NTZ) is an effective drug for the treatment of relapsing-remitting multiple sclerosis. In some patients discontinuation is mandatory due to the risk of progressive multifocal leukoencephalopathy. However, severe clinical and radiological worsening has been described after drug cessation. Our aim was to describe the clinical and radiological features of the rebound phenomenon. MATERIAL AND METHODS: Patients switched from NTZ to Fingolimod (FTY) who had presented a rebound after discontinuation were selected. Clinical and magnetic resonance imaging (MRI) data were collected. RESULTS: Four JC virus positive patients were included. The mean disease duration was 9.5 years (SD: 4.12) with a mean time of 3.1 years on NTZ. All patients started FTY within 3-4 months. Neurological deterioration started in a mean time of 3.5 months (SD: 2.08) with multifocal involvement: 75% motor disturbances, 50% cognitive impairment, 25% seizures. The average worsening in Expanded Disability Status Scale [EDSS] was of 3.25 points (SD: 2.33). The MRI showed a very large increase in T2 and gadolinium-enhanced lesions (mean: 23.67, SD: 18.58). All patients received 5 days of IV methylprednisolone, one patient required plasma exchange. All the patients presented neurological deterioration with an EDSS worsening of 1.13 points (SD: 0.48). After the rebound three patients continued treatment with FTY, only one patient restarted NTZ. CONCLUSION: Discontinuation of NTZ treatment may trigger a severe rebound with marked clinical and radiological worsening. A very careful evaluation of benefit-risk should be considered before NTZ withdrawal, and a close monitoring and a short washout period is recommended after drug withdrawal.

Poor adherence to guidelines for preventing central line-associated bloodstream infections (CLABSI): results of a worldwide survey.

BACKGROUND: Central line-associated bloodstream infections (CLABSI) are a cause of increased morbidity and mortality, and are largely preventable. We documented attitudes and practices in intensive care units (ICUs) in 2015 in order to assess compliance with CLABSI prevention guidelines. METHODS: Between June and October 2015, an online questionnaire was made available to medical doctors and nurses working in ICUs worldwide. We investigated practices related to central line (CL) insertion, maintenance and measurement of CLABSI-related data following the SHEA guidelines as a standard. We computed weighted estimates for high, middle and low-income countries using country population as a weight. Only countries providing at least 10 complete responses were included in these estimates. RESULTS: Ninety five countries provided 3407 individual responses; no low income, 14 middle income (MIC) and 27 high income (HIC) countries provided 10 or more responses. Of the total respondents, 80% (MIC, SE = 1.5) and 81% (HIC, SE = 1.0) reported availability of written clinical guidelines for CLABSI prevention in their ICU; 23% (MIC,SE = 1.7) and 62% (HIC,SE = 1.4) reported compliance to the following (combined) recommendations for CL insertion: hand hygiene, full barrier precaution, chlorhexidine >0.5%, no topic or systemic antimicrobial prophylaxis; 60% (MIC,SE = 2.0) and 73% (HIC,SE = 1.2) reported daily assessment for the need of a central line. Most considered CLABSI measurement key to quality improvement, however few were able to report their CLABSI rate. Heterogeneity between countries was high and country specific results are made available. CONCLUSIONS: This study has identified areas for improvement in CLABSI prevention practices linked to CL insertion and maintenance. Priorities for intervention differ between countries.

Instrumentos de evaluación de la calidad de vida en dermatología / Quality of life in Dermatology: tests for its evaluation

Se puede enfocar la calidad de vida desde la perspectiva de diferentes dimensiones, entre ellas: económica, religiosa, espiritual, sociológica y de salud; los cambios en la percepción de salud pueden afectar cualquiera de estas dimensiones. La satisfacción y el bienestar de los pacientes cobran cada vez mayor importancia. Estas consideraciones han impulsado el desarrollo de escalas para medir y cuantificar la calidad de vida, con el fin de evaluar el impacto sobre ella de las enfermedades crónicas y las intervenciones terapéuticas, así como para definir la asignación de recursos. En la actualidad existen muchas escalas para evaluar la calidad de vida en pacientes dermatológicos, pero las más utilizadas son DLQI y Skindex 29. En este artículo se presenta una revisión de la literatura sobre las escalas de calidad de vida en dermatología.

Quality of life can be approached from the perspective of different dimensions, among them: economic, religious, spiritual, sociological and health-related. Changes in the perception of health can affect either one of these dimensions. Satisfaction and well-being of patients are becoming ever more important. These considerations have stimulated the development of scales to measure and quantify the quality of life in order to assess the impact on it of chronic diseases and therapeutic interventions, as well as to define the allocation of resources. Presently, many scales are available to evaluate the quality of life in dermatological patients; among them, DLQI and Skindex 29 are the most frequently used. We present a review of the literature concerning this subject.

[Stroke in the very old: myths and realities]. / El ictus en pacientes muy ancianos: mitos y realidades.

BACKGROUND AND OBJECTIVE: The incidence of stroke in the very old is increasing. However, there are very few data regarding the differences in the management and outcomes in Spain. MATERIAL AND METHODS: We analyzed the clinical characteristics, diagnostic and therapeutic procedures, medical complications and intrahospitalary mortality in 463 subjects admitted because of ischemic stroke between 2009 and 2010. Very-old patients (≥ 85 year-old) were compared with younger patients. RESULTS: Very old patients showed on admission higher frequency of atrial fibrillation (34 vs 19%, P>.001) and lower use of antiplatelet agents and oral anticoagulants (P<.001). Disability and stroke severity were higher among the very old (P<.001) and the use of diagnostic and therapeutic procedures was significantly lower (P<.001). The length of stay was longer in the very old (12 [6-24] days vs 8 [5-15], P<.001), as wells as the intrahospitalary mortality (27 vs 6%, P<.001). After a multivariate analysis, independent predictive factors of mortality were previous disability, measured by the modified Rankin scale (95% confidence interval [95%CI] 1.6-10.7), impaired level of consciousness (IC95% 2.1-13.9) and stroke severity measured by the National Institutes of Health Stroke Scale (95%CI 1.8-38.1). CONCLUSIONS: Very old patients admitted with ischemic stroke undergo less diagnostic and therapeutic procedures. However, in our study, very old age was not an independent predictor of mortality, which was essentially determined by previous functional status and stroke severity.

Hypothermia during migraine attacks.

Episodic spontaneous hypothermia is an infrequent disorder. Here, the case of a patient with migraine who experienced hypothermia during her migraine attacks is presented. The authors propose that larger clinical series should be studied to evaluate the occurrence of hypothermia in migraine, as well as the possible influence of some preventive regimens in this setting.

Are Cox-2 drugs the second line option in indomethacin responsive headaches?

Paroxysmal hemicrania and hemicrania continua are both indomethacin-responsive headaches. Although indomethacin use to be well tolerated, some patients developed gastrointestinal side effects. We report four cases of hemicrania continua and a patient suffering chronic paroxysmal hemicrania completely responsive to celecoxib. In our experience celecoxib is a good option treatment for patients suffering from hemicrania continua or chronic paroxysmal hemicranea that presents indomethacin adverse effects.

[Is the flashlight test of any use in primary care for detecting eyes with shallow anterior chamber?]. / Es útil la prueba de la linterna en atención primaria para detectar ojos con cámara anterior poco profunda?

OBJECTIVE: To validate and analyse the usefulness of the flashlight test (FT) in detecting eyes with a shallow anterior chamber in diabetic patients in primary care. DESIGN: Cross-sectional descriptive study. SETTING: Urban health centre and a reference ophthalmology department, Logroño, Spain. PARTICIPANTS: A total of 74 patients with diabetes type 2, selected by consecutive sampling from those seen for an annual check-up. Those patients with movement difficulties, diseases and lesions of the eye, which would hamper the examination, were excluded. A total of 145 eyes were analysed. INTERVENTION: A family doctor and the resident performed the FT. The ophthalmologist carried out the Van Herick test without knowing the results of the FT. PRIMARY OUTCOMES: Sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios were calculated. The reproducibility was calculated using weighted kappa index. RESULTS: The kappa index was 75%. The specificity was 88.9% and the sensitivity was 98.9% (95% confidence interval (95% CI) 96.1-100.0%). The likelihood that a patient had a negative result could have an angle with a risk of developing glaucoma was 1.1%. The negative likelihood ratio (NLR) was 0.67%. One patient was incorrectly labelled as not having a narrow angle. CONCLUSIONS: The FT is valid and useful for ruling out shallow anterior chamber in type 2 diabetics. It is a simple and innocuous test that can help the family doctor make a decision on pharmacological mydriasis to observe the back of the eye.