Associations of diabetes, hypertension and obesity with COVID-19 mortality: a systematic review and meta-analysis.

INTRODUCTION: Despite a growing body of scholarly research on the risks of severe COVID-19 associated with diabetes, hypertension and obesity, there is a need for estimating pooled risk estimates with adjustment for confounding effects. We conducted a systematic review and meta-analysis to estimate the pooled adjusted risk ratios of diabetes, hypertension and obesity on COVID-19 mortality. METHODS: We searched 16 literature databases for original studies published between 1 December 2019 and 31 December 2020. We used the adapted Newcastle-Ottawa Scale to assess the risk of bias. Pooled risk ratios were estimated based on the adjusted effect sizes. We applied random-effects meta-analysis to account for the uncertainty in residual heterogeneity. We used contour-funnel plots and Egger's test to assess possible publication bias. RESULTS: We reviewed 34 830 records identified in literature search, of which 145 original studies were included in the meta-analysis. Pooled adjusted risk ratios were 1.43 (95% CI 1.32 to 1.54), 1.19 (95% CI 1.09 to 1.30) and 1.39 (95% CI 1.27 to 1.52) for diabetes, hypertension and obesity (body mass index ≥30 kg/m2) on COVID-19 mortality, respectively. The pooled adjusted risk ratios appeared to be stronger in studies conducted before April 2020, Western Pacific Region, low- and middle-income countries, and countries with low Global Health Security Index scores, when compared with their counterparts. CONCLUSIONS: Diabetes, hypertension and obesity were associated with an increased risk of COVID-19 mortality independent of other known risk factors, particularly in low-resource settings. Addressing these chronic diseases could be important for global pandemic preparedness and mortality prevention. PROSPERO REGISTRATION NUMBER: CRD42021204371.

Mapping an EPA-based comprehensive curricular proposal for UME.

This article was migrated. The article was marked as recommended. In medical education, there have been three important reforms: science-based curriculum, problem-based learning, and competency-based education. Currently, the concept of Entrustable Professional Activities (EPA) goes a step beyond competencies. The aim of this paper is twofold: first, to present a proposal for an EPA-based curriculum for undergraduate medical education, and second, to describe its curricular framework, educational model and organization. This curricular proposal integrates EPA-based education with the foundations of the interpretive epistemology, the constructivist paradigm and the health care transformations. Using Actividades Profesionales Confiables (APROC) as a curricular guideline helps the educators define knowledge, skills, and attitudes; teachers can plan activities that link theory to practice; evaluators can assess the student's performance and provide him with feedback, and Faculty leaders and collaborators can implement projects to improve educational quality. The curriculum proposal includes a flexible modular system, the integration of biomedical, socio-medical and clinical sciences, and a close link between theory and practice. This curriculum puts medical education at the forefront, it favors the comprehensive education of future physicians, and it constitutes a true educational revolution.

Avances del Modelo Educativo para Desarrollar Actividades Profesionales Confiables (MEDAPROC) / Advances of an Educational Model to Develop Entrustable Professional Activities (MEDAPROC)

El Modelo Educativo para Desarrollar Actividades Profesionales Confiables (MEDAPROC) surge como respuesta a la implementación de la educación basada en competencias. Es un proyecto multidisciplinario fundamentado en la epistemología interpretativa, el paradigma constructivista, las transformaciones del Sistema Nacional de Salud y el contexto del ejercicio actual de la medicina. Su meta es favorecer la adquisición de conocimientos, habilidades y actitudes indispensables por parte del estudiante de medicina. Integra la tendencia internacional de las Entrustable Professional Activities y las naturaliza como las Actividades Profesionales Confiables (APROC). MEDAPROC propone que el desarrollo de las APROC se promueva de manera inversa, desde el perfil de egreso hasta el inicio de los estudios de pregrado, por lo tanto, se involucra en diversas fases y procesos de aprendizaje y enseñanza (planeación, didáctica, evaluación y realimentación) por medio de proyectos para implementar estrategias didácticas y recursos de evaluación, con el apoyo de la formación docente, la investigación educativa y la tecnología. Su objetivo es lograr la mejora de la educación médica y de las ciencias de la salud, con el firme propósito de generar un cambio positivo en la calidad de la atención desde el entorno educativo

The Educational Model to Develop Entrustable Professional Activities (MEDAPROC) arises as a response to the implementation of competency-based education. It is a multidisciplinary project based on interpretative epistemology, the constructivist paradigm, the transformations of the national health system, and the context of the current practice of medicine. Its purpose is to encourage the acquisition of essential knowledge, skills, and attitudes by the medical student. It integrates the international trend of the entrustable professional activities and converts them into entrustable professional activities (APROC). MEDAPROC proposes that the development of the APROC be promoted in an inverse manner, from the profile of the graduate to the beginning of the undergraduate studies. Therefore, it is involved in several phases of the learning and teaching process (planning, didactics, assessment, and feedback) through projects to implement didactic strategies and assessment resources, with the support of teacher training, educational research, and technology. Its aim is to improve medical and health sciences education, with the firm purpose of making a positive change in the health care quality from the educational environment