Geospatial investigations in Colombia reveal variations in the distribution of mood and psychotic disorders.

BACKGROUND: Geographical variations in mood and psychotic disorders have been found in upper-income countries. We looked for geographic variation in these disorders in Colombia, a middle-income country. We analyzed electronic health records from the Clínica San Juan de Dios Manizales (CSJDM), which provides comprehensive mental healthcare for the one million inhabitants of Caldas. METHODS: We constructed a friction surface map of Caldas and used it to calculate the travel-time to the CSJDM for 16,295 patients who had received an initial diagnosis of mood or psychotic disorder. Using a zero-inflated negative binomial regression model, we determined the relationship between travel-time and incidence, stratified by disease severity. We employed spatial scan statistics to look for patient clusters. RESULTS: We show that travel-times (for driving) to the CSJDM are less than 1 h for ~50% of the population and more than 4 h for ~10%. We find a distance-decay relationship for outpatients, but not for inpatients: for every hour increase in travel-time, the number of expected outpatient cases decreases by 20% (RR = 0.80, 95% confidence interval [0.71, 0.89], p = 5.67E-05). We find nine clusters/hotspots of inpatients. CONCLUSIONS: Our results reveal inequities in access to healthcare: many individuals requiring only outpatient treatment may live too far from the CSJDM to access healthcare. Targeting of resources to comprehensively identify severely ill individuals living in the observed hotspots could further address treatment inequities and enable investigations to determine factors generating these hotspots.

The frequencies of mental disorders vary by geographic region. Investigating such variations may lead to more equitable access to mental healthcare and to scientific discoveries that reveal specific localized factors that contribute to the causes of mental illness. This study examined the frequency of three disorders with a major impact on public health ­ schizophrenia, bipolar disorder, and major depressive disorder ­ by analyzing electronic health records from a hospital providing comprehensive mental health care for a large region in Colombia. We show that individuals receiving outpatient care mainly live relatively near the facility. Those receiving inpatient care live throughout the region, but cluster in a few scattered locations. Future research could lead to strategies for more equitable provision of mental healthcare in Colombia and identify environmental or genetic factors that affect the likelihood that someone will develop one of these disorders.

Perception of Race and Sex Diversity in Ophthalmology by Artificial Intelligence: A DALL E-2 Study.

Purpose: In the past few years, there has been remarkable progress in accessibility of open-source artificial intelligence (AI) image generators, developed to help humans understand how AI sees our world. Here, we characterize perception of racial and sex diversity in ophthalmology by AI. Methods: OpenAI's open-source DALL E-2 AI was used for image generation of ophthalmologists with queries that all included "American" and "portrait photo". Factors used for queries contained categories of following: "Positive Characteristic", "Negative Characteristic", "Finances", "Region", "Experience", "Academic Rank", and "Subspecialty". The first 40 faces for each search were categorized on the basis of race and sex by two independent reviewers. If race or sex was not agreed upon, a third reviewer independently provided a classification, or if still indeterminate, the image was labeled as such. Images that did not adequately show facial features were excluded from categorization. Results: A total of 1560 images were included in the analysis. Control search queries specifying solely ophthalmologist sex and/or race outputted (100%) accurate images validating the tool. The query "American ophthalmologist, portrait photo" portrayed the majority of ophthalmologists as White (75%) and male (77.5%). Young/inexperienced/amateur ophthalmologists were perceived to have greater non-White racial diversity (27.5%) and female representation (28.3%) relative to old/experienced/mature ophthalmologists (23.3% non-White and 18.3% female). Ophthalmology department chairs (25%) had slightly more racial diversity compared to residents (22.5%), but residents had greater female representation (30%) compared to chairs (15%). Conclusion: Our results suggest the DALL E-2 AI may perceive a trend of increasing racial and sex diversity in younger, newer ophthalmologists compared to more senior ophthalmologists. Future investigations should attempt to validate how AI may be used as a tool to evaluate ophthalmology's progress towards becoming more inclusive of increasingly diverse ophthalmologists.

Electroconvulsive Therapy Impact on Memory Performance in Patients With Depression.

INTRODUCTION: The safety of electroconvulsive therapy has improved greatly over the last decades, making the potentially adverse effects on memory and other neurocognitive functions the main clinical aspect of concern in the present. In Colombia, the general population and healthcare professionals (even some psychiatrists) seem to have mostly negative opinions towards electroconvulsive therapy treatment, but maybe this could be reconsidered if more information is provided; therefore, the aim of the present study was to evaluate the changes in memory and the severity of the symptoms in a group of patients with severe depression before and after electroconvulsive therapy. METHODS: Twenty-three patients ranging in age from 23 to 70 years from the electroconvulsive therapy service at the San Juan de Dios Clinic (Manizales, Colombia) were recruited in order to assess the effect of electroconvulsive therapy on memory in patients with severe depression. Depressive symptoms and memory were assessed with the Hamilton Depression Scale (HAMD) and Rey Auditory Verbal Learning Test (RAVLT), respectively. The assessment was administered to participants before the initial treatment of electroconvulsive therapy series (0-1 day) and 2 days after their last treatment. RESULTS: Electroconvulsive therapy resulted in significant improvement in the rating of depression. There were no significant differences in the five learning trials, delayed recall, learning and forgetting scores from pre-treatment to post-treatment. Significant pre-treatment/post-treatment differences were found in the delayed recognition trial. CONCLUSIONS: Pre- and post- electroconvulsive therapy cognitive assessment is a feasible and useful procedure. In general, memory performance does not worsen after electroconvulsive therapy in patients with depression. Only delayed recognition is affected a few days following electroconvulsive therapy, particularly in patients with low educational level and bitemporal (BT) electrode placement.

Impacto de la Terapia Electroconvulsiva en el Funcionamiento de la Memoria en Pacientes con Depresión

Introducción: La seguridad de la terapia electroconvulsiva ha mejorado mucho en las últimas décadas, lo que hace que los efectos potencialmente adversos en la memoria y otras funciones neurocognitivas sean el principal aspecto clínico de preocupación en el presente. En Colombia, la población general y los profesionales de la salud (incluso algunos psiquiatras) parecen tener opiniones mayoritariamente negativas sobre el tratamiento electroconvulsivo, pero quizá esto podría reconsiderarse si se brinda más información; por lo tanto, el objetivo del presente estudio es evaluar los cambios en la memoria y la gravedad de los síntomas en un grupo de pacientes con depresión grave antes y después de la terapia electroconvulsiva. Métodos: Se incluyó a 23 pacientes con edades comprendidas entre los 23 y los 70 anos del Servicio de Terapia Electroconvulsiva de la Clínica San Juan de Dios (Manizales, Colombia) para evaluar el efecto de esta terapia en la memoria de pacientes con depresión grave. Los síntomas depresivos y la memoria se evaluaron con la escala de depresión de Hamilton (HAMD) y la prueba de aprendizaje auditivo verbal de Rey (RAVLT) respectivamente. Se evaluó a los participantes antes de la sesión inicial de la serie de terapia electroconvulsiva (0-1 día) y 2 días después de su último tratamiento. Resultados: La terapia electroconvulsiva resultó en una mejora significativa en la puntuación de depresión. No hubo diferencias significativas en las puntuaciones de las 5 pruebas de aprendizaje, recuerdo retardado, aprendizaje y olvido desde antes del tratamiento hasta después de este. Se encontraron diferencias significativas antes y después del tratamiento en la prueba de reconocimiento retardado. Conclusiones: Los problemas de memoria pueden evaluarse y caracterizarse de manera práctica tras la terapia electroconvulsiva. La evaluación cognitiva antes y después de la terapia electroconvulsiva es un procedimiento viable y útil. En general, el rendimiento de la memoria no empeora después de la terapia electroconvulsiva en pacientes con depresión. Solo el reconocimiento retardado se ve afectado unos días después, particularmente en pacientes con bajo nivel educativo y colocación de electrodos bitemporales (BT).

Introduction: The safety of electroconvulsive therapy has improved greatly over the last decades, making the potentially adverse effects on memory and other neurocognitive functions the main clinical aspect of concern in the present. In Colombia, the general population and healthcare professionals (even some psychiatrists) seem to have mostly negative opinions towards electroconvulsive therapy treatment, but maybe this could be reconsidered if more information is provided; therefore, the aim of the present study was to evaluate the changes in memory and the severity of the symptoms in a group of patients with severe depression before and after electroconvulsive therapy. Methods: Twenty-three patients ranging in age from 23 to 70 years from the electroconvulsive therapy service at the San Juan de Dios Clinic (Manizales, Colombia) were recruited in order to assess the effect of electroconvulsive therapy on memory in patients with severe depression. Depressive symptoms and memory were assessed with the Hamilton Depression Scale (HAMD) and Rey Auditory Verbal Learning Test (RAVLT), respectively. The assessment was administered to participants before the initial treatment of electroconvulsive therapy series (0-1 day) and 2 days after their last treatment. Results: Electroconvulsive therapy resulted in significant improvement in the rating of depression. There were no significant differences in the five learning trials, delayed recall, learning and forgetting scores from pre-treatment to post-treatment. Significant pre-treatment/post-treatment differences were found in the delayed recognition trial. Conclusions: Pre- and post- electroconvulsive therapy cognitive assessment is a feasible and useful procedure. In general, memory performance does not worsen after electroconvulsive therapy in patients with depression. Only delayed recognition is affected a few days following electroconvulsive therapy, particularly in patients with low educational level and bitemporal (BT) electrode placement.

Diseño y validez de contenido del cuestionario continuidad del cuidado entre niveles asistenciales / Design and content validity of the Continuity of Care Across Levels of Care Questionnaire

Introducción: La falta de continuidad del cuidado puede ocasionar omisiones o duplicaciones en las acciones dirigidas al cuidado de usuarios con Enfermedades Crónicas No Transmisibles (ECNT), generando un posible deterioro de su salud. Particularmente, en México y Colombia no existe un instrumento que evalúe la continuidad del cuidado que incluya sus tres elementos esenciales. Objetivos: Diseñar un instrumento que evalúe la continuidad del cuidado entre niveles asistenciales en usuarios con ECNT en México y Colombia; y validar el contenido del cuestionario por medio de un juicio de expertos en versiones adaptadas al contexto mexicano y colombiano. Materiales y Métodos: Se diseñó el cuestionario Continuidad del Cuidado entre Niveles Asistenciales. Se realizó el proceso de validación de contenido por expertos usando el método Delphi. Se seleccionaron 16 jueces expertos (8 por país). Los ítems del cuestionario fueron evaluados bajo cuatro categorías: suficiencia, claridad, coherencia y relevancia. Se realizaron dos rondas de evaluación para determinar el grado de concordancia entre jueces. Resultados: El cuestionario obtuvo un Coeficiente de Validez de Contenido General "Excelente" para ambos países (0,97). La versión final quedó conformada por 85 ítems divididos en tres secciones. Discusión: Este instrumento, a diferencia de otros, evalúa desde la experiencia de los usuarios con ECNT la continuidad del cuidado de forma multidisciplinaria en los tres niveles de atención. Conclusión: El cuestionario alcanzó una validez de contenido esperada usando el método Delphi, para evaluar la continuidad del cuidado entre niveles asistenciales en usuarios con ECNT según el contexto mexicano y colombiano.

Introduction: In the absence of continuity of care, actions aimed at the care of users with chronic non-communicable diseases (NCDs) may be omitted or duplicated, which can potentially worsen users' health. In Mexico and Colombia, in particular, there is no instrument for assessing continuity of care that includes its three essential elements. Objective: To develop an instrument to assess care continuity across levels of care for users with NCDs in Mexico and Colombia and validate the content of the questionnaire through expert judgment of versions adapted to the Mexican and Colombian contexts. Materials and Methods: The Continuity of Care across Levels of Care Questionnaire was designed. The content validation process was carried out by experts using the Delphi technique. Sixteen experts were selected (8 per country). Questionnaire items were assessed in four categories: sufficiency, clarity, coherence, and relevance. Two assessment rounds were conducted to determine the level of experts' agreement. Results: The questionnaire obtained an 'Excellent' overall Content Validity Coefficient in both countries (0.97). Discussion: This instrument, unlike others, assesses the continuity of care in a multidisciplinary manner across the three levels of care from the experience of users with NCDs. Conclusion: The questionnaire achieved the expected content validity using the Delphi technique to assess care continuity across levels of care for users with NCDs, according to the Mexican and Colombian contexts.

Introdução: A falta de continuidade do cuidado pode ocasionar omissões ou duplicidades nas ações voltadas para o atendimento aos usuários com Doenças Crônicas Não Transmissíveis (DCNT), gerando um possível agravamento de sua saúde. Particularmente, no México e na Colômbia não existe um instrumento que avalie a continuidade do cuidado que inclua seus três elementos essenciais. Objetivo: Desenhar um instrumento que avalie a continuidade do cuidado entre os níveis de atenção em usuários com DCNT no México e na Colômbia; e validar o conteúdo do questionário por meio de julgamento de especialistas em versões adaptadas ao contexto mexicano e colombiano. Materiais e Métodos: Foi elaborado o questionário de Continuidade de Cuidados entre os Níveis de Cuidados. O processo de validação de conteúdo foi realizado por especialistas por meio do método Delphi. Foram selecionados 16 juízes especialistas (8 por país). Os itens do questionário foram avaliados em quatro categorias: suficiência, clareza, coerência e relevância. Duas rodadas de avaliação foram realizadas para determinar o grau de concordância entre os juízes. Resultados: O questionário obteve um Coeficiente de Validade de Conteúdo Geral "Excelente" para ambos os países (0,97). A versão final foi composta por 85 itens divididos em três seções. Discussão: Este instrumento, diferente de outros, avalia a partir da experiência dos usuários com DCNT a continuidade do cuidado de forma multidisciplinar nos três níveis de atenção. Conclusão: O questionário atingiu a validade de conteúdo esperada usando o método Delphi, para avaliar a continuidade do cuidado entre níveis de atenção em usuários com DCNT de acordo com o contexto mexicano e colombiano.

Effect of Vancomycin Applied to the Surgical Site on Fracture Healing in a Diabetic Rat Model.

BACKGROUND: Prophylactic vancomycin treatment decreases the prevalence of surgical site and deep infections by >70% in diabetic patients undergoing reconstructive foot and ankle surgery. Thus, determining whether clinically relevant local vancomycin doses affect diabetic fracture healing is of medical interest. We hypothesized that application of vancomycin powder to the fracture site during surgery would not affect healing outcomes, but continuous exposure of vancomycin would inhibit differentiation of osteoblast precursor cells and their osteogenic activity in vitro. METHODS: The vancomycin dose used to treat the diabetic rats was a modest increase to routine surgical site vancomycin application of 1 to 2 g for a 70-kg adult (21 mg/kg). After femur fracture in BB-Wistar type 1 diabetic rats, powdered vancomycin (25 mg/kg) was administered to the fracture site. Bone marrow and periosteal cells isolated from diabetic bones were cultured and treated with increasing levels of vancomycin (0, 5, 50, 500, or 5000 µg/mL). RESULTS: Radiographic scoring, micro-computed tomography (µCT) analysis, and torsion mechanical testing failed to identify any statistical difference between the vancomycin-treated and the untreated fractured femurs 6 weeks postfracture. Low to moderate levels of vancomycin treatment (5 and 50 µg/mL) did not impair cell viability, osteoblast differentiation, or calcium deposition in either the periosteum or bone marrow-derived cell cultures. In contrast, high doses of vancomycin (5000 µg/mL) did impair viability, differentiation, and calcium deposition. CLINICAL RELEVANCE: In this diabetic rodent fracture model, vancomycin powder application at clinically relevant doses did not affect fracture healing or osteogenesis.

Local zinc treatment enhances fracture callus properties in diabetic rats.

The effects of locally applied zinc chloride (ZnCl2 ) on early and late-stage parameters of fracture healing were evaluated in a diabetic rat model. Type 1 Diabetes has been shown to negatively impact mechanical parameters of bone as well as biologic markers associated with bone healing. Zinc treatments have been shown to reverse those outcomes in tests of nondiabetic and diabetic animals. This study is the first to assess the efficacy of a noncarrier mediated ZnCl2 on bony healing in diabetic animals. This is a promising basic science approach which may lead to benefits for diabetic patients in the future. Treatment and healing were assessed through quantification of callus zinc, radiographic scoring, microcomputed tomography (µCT), histomorphometry, and mechanical testing. Local ZnCl2 treatment increased callus zinc levels at 1 and 3 days after fracture (p ≤ 0.025). Femur fractures treated with ZnCl2 showed increased mechanical properties after 4 and 6 weeks of healing. Histomorphometry of the ZnCl2 -treated fractures found increased callus cartilage area at Day 7 (p = 0.033) and increased callus bone area at Day 10 (p = 0.038). In contrast, callus cartilage area was decreased (p < 0.01) after 14 days in the ZnCl2 -treated rats. µCT analysis showed increased bone volume in the fracture callus of ZnCl2 -treated rats at 6 weeks (p = 0.0012) with an associated increase in the proportion of µCT voxel axial projections (Z-rays) spanning the fracture site. The results suggest that local ZnCl2 administration improves callus chondrogenesis leading to greater callus bone formation and improved fracture healing in diabetic rats.

Impacto da epidemia de COVID-19 na mortalidade em prisões / Impact of the COVID-19 epidemic on mortality in prisons

Resumo O objetivo deste artigo é avaliar o impacto da COVID-19 na mortalidade das pessoas privadas de liberdade (PPL) no estado do Rio de Janeiro e comparar as taxas observadas com as da população geral. Estudo quantitativo, retrospectivo, que associa análise de série histórica 2016-2021 de taxa anual de mortalidade, seccional, comparando 2016-2017 vs. 2020-2021 e análise de dados individuais obtidos a partir de fontes primárias e secundárias de informação. A razão de mortalidade padronizada entre PPL e população geral foi estimada para os grupos de causa. Série histórica mostrou queda anual (13%) da mortalidade de 2016 a 2019, tendência que se inverteu em 2020 devido à COVID-19, responsável por 20% do total de mortes. Das PPL que morreram por COVID-19, 54,8% eram idosas e/ou portadoras de comorbidade. A mortalidade por COVID-19 foi semelhante entre a PPL e a população geral, mas a mortalidade por tuberculose e HIV permaneceu muito mais elevada entre as PPL. A pandemia foi provavelmente determinante para a reversão da tendência de queda na mortalidade observada entre 2016 e 2019. A utilização da mortalidade como indicador de saúde e direitos humanos nas prisões por órgãos de saúde, justiça e organizações da sociedade civil implica o aprimoramento da informação sobre PPL no SIM.

Abstract Purpose: to assess the impact of COVID-19 on the mortality of people deprived of their liberty (PDL) in the state of Rio de Janeiro and compare the rates observed with those of the general population. Method: quantitative, retrospective study combining the analysis of the 2016-2021 time series of annual mortality rates, cross-sectional study comparing 2016-2017 vs. 2020-2021 and analysis of individual data obtained from primary and secondary sources of information. The standardized mortality ratio between PDL and the general population was estimated for the cause of death categories. Results: historical series showed an annual drop (13%) in mortality from 2016 to 2019, a trend that was inverted in 2020 due to COVID-19, which was responsible for 20% of all deaths. Of the COVID-19 deaths, 54.8% were elderly and/or had co-morbidities. Mortality from COVID-19 was similar between PDL and the general population, but mortality from tuberculosis and HIV remained much higher among PDL. Conclusion: the pandemic was probably a determinant of the downward trend reversal in mortality between 2016 and 2019. Using mortality as an indicator of health and human rights in prisons by health, justice and civil society organizations implies the improvement of information about PDL in the SIM.

Análise do cuidado em saúde no sistema prisional do Pará, Brasil / Analysis of health care in prisons of Pará state, Brazil

Resumo Este trabalho buscou descrever a saúde prisional paraense. Trata-se de estudo ecológico, em série temporal, baseado em dados secundários de acesso irrestrito a partir de relatórios institucionais do sistema penitenciário, além de informações provenientes do Portal da Transparência do Pará, do Cadastro Nacional de Estabelecimentos de Saúde (CNES) e do Sistema de Informação de Agravos de Notificação (SINAN). Como resultados, observou-se uma população de maioria jovem, negra e parda, de baixa escolaridade e do sexo masculino. Constatou-se um aumento, em números absolutos, de profissionais de saúde, mas sem acompanhar proporcionalmente o aumento da população carcerária. O número de consultas médicas, odontológicas e psicológicas variou de forma aleatória e fora dos limites quando inseridos em gráficos de controle estatístico. O potencial de cobertura das equipes de saúde prisional vinculadas aos SUS foi de no máximo 45,77%. Mutirões de saúde não aumentaram o número o total de consultas. A incidência de tuberculose mostrou-se muito superior à média para população do estado e sua notificação mostrou-se adequada. Mesmo trabalhando com dados secundários restritos, pôde-se lançar um amplo olhar sobre a saúde prisional do estado, levantando questões que devem ser apreciadas por gestores e profissionais.

Abstract This study aimed to describe Pará's Prison Health. This ecological time series study was based on secondary data with unrestricted access from Institutional Reports of the Penitentiary System and information from the Pará Transparency Web Portal, the National Register of Health Facilities (CNES), and the Notifiable Diseases Information System (SINAN). As a result, we observed a population with a majority of less-educated young black and brown males. In absolute numbers, we observed an increase of health professionals who did not follow the prison population hike. When entered into statistical control charts, the number of medical, dental, and psychological visits varied randomly and outside the limits. The potential coverage of prison health teams linked to the SUS achieved a maximum of 45.77%. Health task forces did not increase the number of visits. The incidence of tuberculosis was much higher than the mean for the state population, and its notification is adequate. Even with restricted secondary data, we could broadly look at the state's prison health, raising issues managers and professionals should consider.

Analysis of health care in prisons of Pará state, Brazil. / Análise do cuidado em saúde no sistema prisional do Pará, Brasil.

This study aimed to describe Pará's Prison Health. This ecological time series study was based on secondary data with unrestricted access from Institutional Reports of the Penitentiary System and information from the Pará Transparency Web Portal, the National Register of Health Facilities (CNES), and the Notifiable Diseases Information System (SINAN). As a result, we observed a population with a majority of less-educated young black and brown males. In absolute numbers, we observed an increase of health professionals who did not follow the prison population hike. When entered into statistical control charts, the number of medical, dental, and psychological visits varied randomly and outside the limits. The potential coverage of prison health teams linked to the SUS achieved a maximum of 45.77%. Health task forces did not increase the number of visits. The incidence of tuberculosis was much higher than the mean for the state population, and its notification is adequate. Even with restricted secondary data, we could broadly look at the state's prison health, raising issues managers and professionals should consider.

Este trabalho buscou descrever a saúde prisional paraense. Trata-se de estudo ecológico, em série temporal, baseado em dados secundários de acesso irrestrito a partir de relatórios institucionais do sistema penitenciário, além de informações provenientes do Portal da Transparência do Pará, do Cadastro Nacional de Estabelecimentos de Saúde (CNES) e do Sistema de Informação de Agravos de Notificação (SINAN). Como resultados, observou-se uma população de maioria jovem, negra e parda, de baixa escolaridade e do sexo masculino. Constatou-se um aumento, em números absolutos, de profissionais de saúde, mas sem acompanhar proporcionalmente o aumento da população carcerária. O número de consultas médicas, odontológicas e psicológicas variou de forma aleatória e fora dos limites quando inseridos em gráficos de controle estatístico. O potencial de cobertura das equipes de saúde prisional vinculadas aos SUS foi de no máximo 45,77%. Mutirões de saúde não aumentaram o número o total de consultas. A incidência de tuberculose mostrou-se muito superior à média para população do estado e sua notificação mostrou-se adequada. Mesmo trabalhando com dados secundários restritos, pôde-se lançar um amplo olhar sobre a saúde prisional do estado, levantando questões que devem ser apreciadas por gestores e profissionais.

COVID-19 nas prisões: o que o telejornalismo (não) mostrou - um estudo sobre os critérios de noticiabilidade na pandemia / COVID-19 in prisons: what telejournalism (not) showed - a study on the criteria for newsworthiness during the pandemic

Resumo Para analisar a cobertura telejornalística da pandemia de COVID-19 nas prisões brasileiras e sua visibilidade, foram examinadas 213 matérias veiculadas entre março e dezembro de 2020, encontradas no serviço de buscas da plataforma digital de vídeos por streaming Globoplay. A maior parte foi ao ar em março, abril e julho, com importante redução nos meses subsequentes. As reportagens, sobre números de mortes ou infectados, medidas de prevenção e prisão domiciliar ou liberdade para grupos de risco da COVID-19, foram divulgadas principalmente nos jornais locais. Os órgãos de saúde quase não foram ouvidos. Das 19 notícias apresentadas nacionalmente, 12 abordam os "presos famosos" e a legitimidade da prisão domiciliar ou a liberdade para grupos de risco da COVID-19. As pautas sanitárias e de garantia do direito à saúde das pessoas privadas de liberdade ficaram limitadas às dificuldades para a efetivação nos presídios das medidas de proteção e a sustentar a necessidade de medidas restritivas à movimentação no interior das prisões e nos intercâmbios com o exterior para limitar a circulação do vírus. Em geral, a forma e a visibilidade dadas ao tema não contribuem para ampliar a percepção dos telespectadores sobre as condições sanitárias das prisões e o fato de que a saúde é um direito de todos, sem qualquer distinção.

Abstract To analyze the news coverage of the COVID-19 pandemic in Brazilian prisons and its visibility, 213 articles broadcast between March and December 2020 were examined, found in the search service of the digital streaming video platform Globoplay. Most aired in March, April and July, with the theme almost disappearing in subsequent months. The reports, on numbers of deaths or infections, prevention measures and house arrest or freedom for groups at risk of COVID-19 were mainly published in local telejournals. Health agencies were barely heard. Of the 19 news items presented nationally, 12 address "famous prisoners" and the legibility of house arrest or freedom for groups at risk of COVID-19 unfavorable outcome. The health guidelines and the guarantee of the right to health of persons deprived of liberty were limited to the difficulties in implementing protection measures in prisons and to sustaining the need for restrictive measures to move inside prisons and in exchanges with the outside, to limit the circulation of the virus. In general, the form and visibility given to the topic do not contribute to broadening the viewers' perception of the sanitary conditions in prisons and the fact that health is a right for all, without any distinction.

COVID-19 in prisons: what telejournalism (not) showed - a study on the criteria for newsworthiness during the pandemic. / COVID-19 nas prisões: o que o telejornalismo (não) mostrou - um estudo sobre os critérios de noticiabilidade na pandemia.

To analyze the news coverage of the COVID-19 pandemic in Brazilian prisons and its visibility, 213 articles broadcast between March and December 2020 were examined, found in the search service of the digital streaming video platform Globoplay. Most aired in March, April and July, with the theme almost disappearing in subsequent months. The reports, on numbers of deaths or infections, prevention measures and house arrest or freedom for groups at risk of COVID-19 were mainly published in local telejournals. Health agencies were barely heard. Of the 19 news items presented nationally, 12 address "famous prisoners" and the legibility of house arrest or freedom for groups at risk of COVID-19 unfavorable outcome. The health guidelines and the guarantee of the right to health of persons deprived of liberty were limited to the difficulties in implementing protection measures in prisons and to sustaining the need for restrictive measures to move inside prisons and in exchanges with the outside, to limit the circulation of the virus. In general, the form and visibility given to the topic do not contribute to broadening the viewers' perception of the sanitary conditions in prisons and the fact that health is a right for all, without any distinction.

Para analisar a cobertura telejornalística da pandemia de COVID-19 nas prisões brasileiras e sua visibilidade, foram examinadas 213 matérias veiculadas entre março e dezembro de 2020, encontradas no serviço de buscas da plataforma digital de vídeos por streaming Globoplay. A maior parte foi ao ar em março, abril e julho, com importante redução nos meses subsequentes. As reportagens, sobre números de mortes ou infectados, medidas de prevenção e prisão domiciliar ou liberdade para grupos de risco da COVID-19, foram divulgadas principalmente nos jornais locais. Os órgãos de saúde quase não foram ouvidos. Das 19 notícias apresentadas nacionalmente, 12 abordam os "presos famosos" e a legitimidade da prisão domiciliar ou a liberdade para grupos de risco da COVID-19. As pautas sanitárias e de garantia do direito à saúde das pessoas privadas de liberdade ficaram limitadas às dificuldades para a efetivação nos presídios das medidas de proteção e a sustentar a necessidade de medidas restritivas à movimentação no interior das prisões e nos intercâmbios com o exterior para limitar a circulação do vírus. Em geral, a forma e a visibilidade dadas ao tema não contribuem para ampliar a percepção dos telespectadores sobre as condições sanitárias das prisões e o fato de que a saúde é um direito de todos, sem qualquer distinção.

[Mortality and causes of deaths in prisons in Rio de Janeiro, Brazil]. / Mortalidade e causas de óbitos nas prisões do Rio de Janeiro, Brasil.

Mortality in prisons, a basic indicator of the right to health for incarcerated persons, has never been studied extensively in Brazil. An assessment of all-cause and cause-specific mortality in prison inmates was conducted in 2016-2017 in the state of Rio de Janeiro, based on data from the Mortality Information System and Prison Administration. Mortality rates were compared between prison population and general population after standardization. The leading causes of death in inmates were infectious diseases (30%), cardiovascular diseases (22%), and external causes (12%). Infectious causes featured HIV/AIDS (43%) and TB (52%, considering all deaths with mention of TB). Only 0.7% of inmates who died had access to extramural health services. All-cause mortality rate was higher among prison inmates than in the state's general population. Among inmates, mortality from infectious diseases was 5 times higher, from TB 15 times higher, and from endocrine diseases (especially diabetes) and cardiovascular diseases 1.5 and 1.3 times higher, respectively, while deaths from external causes were less frequent in prison inmates. The study revealed important potentially avoidable excess deaths in prisons, reflecting lack of care and exclusion of this population from the Brazilian Unified National Health System. This further highlights the need for a precise and sustainable real-time monitoring system for deaths, in addition to restructuring of the prison staff through implementation of the Brazilian National Policy for Comprehensive Healthcare for Persons Deprived of Freedom in the Prison System in order for inmates to fully access their constitutional right to health with the same quality and timeliness as the general population.

A mortalidade nas prisões, indicador fundamental do direito à saúde das pessoas privadas de liberdade (PPL), nunca foi estudada de maneira aprofundada no Brasil. A avaliação da mortalidade global e por causas entre PPL encarceradas em 2016-2017 no Estado do Rio de Janeiro, foi realizada a partir de dados do Sistema de Informações sobre Mortalidade e da Administração Penitenciária. Taxas de mortalidade entre PPL e população geral do estado foram comparadas após padronização. As principais causas de morte entre PPL foram doenças infecciosas (30%), doenças do aparelho circulatório (22%) e causas externas (12%). Dentre as causas infecciosas, destacam-se HIV/aids (43%) e tuberculose (TB) (52% se considerados todos os óbitos com menção de TB). Somente 0,7% das PPL que faleceram tiveram acesso a serviço de saúde extramuros. A taxa global de mortalidade foi maior entre as PPL comparadas à população geral do estado, com mortalidade por doenças infecciosas 5 vezes superior, por TB 15 vezes e por doenças endócrinas, especialmente diabetes, e doenças circulatórias (1,5 e 1,3 vez, respectivamente), enquanto mortes por causa externa foram menos frequentes entre PPL. Este estudo mostra um expressivo excesso de mortes potencialmente evitáveis nas prisões, o que traduz importante desassistência e exclusão dessa população do Sistema Único de Saúde. Evidencia a necessidade de um sistema de monitoramento, em tempo real, dos óbitos, preciso e sustentável, além da reestruturação da saúde prisional por meio da efetivação da Política Nacional de Atenção Integral à Saúde das Pessoas Privadas de Liberdade no Sistema Prisional para que as PPL usufruam do direito constitucional à saúde em sua integralidade, com a mesma qualidade e tempestividade oferecida à população geral.

La mortalidad en las prisiones, indicador fundamental del derecho a la salud de personas privadas de libertad (PPL), nunca se estudió profundamente en Brasil. La evaluación de la mortalidad global y por causas entre PPL, encarceladas en 2016-2017 en el estado de Rio de Janeiro, se realizó a partir de datos del Sistema de Información de Mortalidad y la Administración Penitenciaria. Se compararon las tasas de mortalidad entre PPL y población general del estado tras la estandarización. Las principales causas de muerte entre PPL fueron: enfermedades infecciosas (30%), enfermedades del aparato circulatorio (22%) y causas externas (12%). Entre las causas infecciosas, se destacan VIH/sida (43%) y tuberculosis (TB) (52%, si se consideran todos los óbitos con mención TB). Solamente un 0,7% de las PPL que fallecieron tuvieron acceso a un servicio de salud extramuros. La tasa global de mortalidad fue mayor entre las PPL, comparada con la población general del estado. Entre las PPL, la mortalidad por enfermedades infecciosas fue 5 veces superior, por TB 15 veces, y por enfermedades endocrinas, especialmente diabetes, y enfermedades circulatorias (1,5 y 1,3 veces respectivamente), mientras que las muertes por causa externa fueron menos frecuentes entre PPLs. Este estudio muestra un expresivo exceso de muertes potencialmente evitables en las prisiones, lo que se traduce en una importante desasistencia y la exclusión de esta población del Sistema Único de Salud. Pone en evidencia la necesidad de un sistema de supervisión en tiempo real de los óbitos, preciso y sostenible, además de la reestructuración de la salud en las prisiones, mediante la efectivización de la Política Nacional de Atención Integral a la Salud de las Personas Privadas de Libertad en el Sistema Penitenciario para que las PPLs disfruten del derecho constitucional a la salud en su integridad, con la misma calidad y oportunidad ofrecida a la población general.

A systematic review on the use of ultrasound enhancing agents with transesophageal echocardiography to assess the left atrial appendage prior to cardioversion.

BACKGROUND: Assessment of the left atrium and atrial appendage (LAA) for thrombus by transesophageal echocardiography (TEE) may be suboptimal due to difficult imaging windows and ultrasound artifacts. The present study analyzed the benefit of using ultrasound enhancing agents (UEAs) with TEE to improve diagnostic accuracy and image quality. METHODS: A systematic review of studies published through December 2020 was performed, and included investigations comparing the number of cases deemed indeterminate for visualization of LAA thrombi on TEE pre- versus post-UEAs prior to cardioversion for atrial fibrillation or flutter (AF). Study results were pooled where the number of indeterminate cases by conventional TEE were re-classified as thrombus present, indeterminate, or thrombus excluded following administration of UEAs. RESULTS: Three studies with a total of 399 patients were identified. Of these, 83 (26%) participants met the inclusion criteria. The mean age of the study population from the three studies was 66 ± 12 years, 29% were female, and prevalence of congestive heart failure or neurologic events was 22% and 5%, respectively. Use of UEAs with TEE re-classified 66% (55/83) of cases initially deemed to be indeterminate for LAA thrombus on conventional TEE. Thrombus was present in 13% (11/83) and excluded in 53% (44/83) of cases; 34% (28/83) of cases remained indeterminate on TEE post-UEAs. There were no complications reported with the administration of UEAs. CONCLUSION: Adjunctive use of UEAs with TEE can facilitate the diagnosis or exclusion of LAA thrombus, and improve the procedural confidence and cost-efficiency of cardioversion for AF.

Electroconvulsive Therapy Impact on Memory Performance in Patients With Depression.

INTRODUCTION: The safety of electroconvulsive therapy has improved greatly over the last decades, making the potentially adverse effects on memory and other neurocognitive functions the main clinical aspect of concern in the present. In Colombia, the general population and healthcare professionals (even some psychiatrists) seem to have mostly negative opinions towards electroconvulsive therapy treatment, but maybe this could be reconsidered if more information is provided; therefore, the aim of the present study was to evaluate the changes in memory and the severity of the symptoms in a group of patients with severe depression before and after electroconvulsive therapy. METHODS: Twenty-three patients ranging in age from 23 to 70 years from the electroconvulsive therapy service at the San Juan de Dios Clinic (Manizales, Colombia) were recruited in order to assess the effect of electroconvulsive therapy on memory in patients with severe depression. Depressive symptoms and memory were assessed with the Hamilton Depression Scale (HAMD) and Rey Auditory Verbal Learning Test (RAVLT), respectively. The assessment was administered to participants before the initial treatment of electroconvulsive therapy series (0-1 day) and 2 days after their last treatment. RESULTS: Electroconvulsive therapy resulted in significant improvement in the rating of depression. There were no significant differences in the five learning trials, delayed recall, learning and forgetting scores from pre-treatment to post-treatment. Significant pre-treatment/post-treatment differences were found in the delayed recognition trial. CONCLUSIONS: Pre- and post- electroconvulsive therapy cognitive assessment is a feasible and useful procedure. In general, memory performance does not worsen after electroconvulsive therapy in patients with depression. Only delayed recognition is affected a few days following electroconvulsive therapy, particularly in patients with low educational level and bitemporal (BT) electrode placement.

Management of peri-device leak following left atrial appendage closure: A systematic review.

OBJECTIVE: This study aimed to examine the cumulative experience of peri-device leak (PDL) closure following left atrial appendage (LAA) closure. BACKGROUND: The management of PDL following LAA closure remains controversial. While PDL closure has been proposed, procedural features and clinical outcomes have not been well established. METHODS: A systematic review of all published cases of PDL closure with available anatomical, procedural, and clinical outcomes was performed. RESULTS: We identified 18 indexed publications and 110 cases between April 2013 and March 2020. 71 patients (mean age 72 ± 8 yrs), met study criteria and were included. PDL closure was most common in males, bilobar LAA morphology, and after Watchman procedures. The mean PDL size was 7.6 ± 5.8 mm (range 2-26 mm). Leaks were classified according to size: small (<5 mm; 45%), moderate (≥5-9 mm; 25%), and large (≥10 mm; 30%). Endovascular coils and endovascular plugs were used to close both small and moderate sized leaks, and second LAA closure devices were exclusively used for large PDLs. Successful PDL closure occurred in 90%, and was similar between PDL sizes and types of occluder used. Procedural complication rates were uncommon (2.8%). No strokes were reported following PDL closure at 6 months. CONCLUSIONS: In patients with PDL for whom discontinuation of OAC may be considered unsafe, percutaneous closure using a tailored approach with either endovascular coils, plugs, or second occluder represents a safe, and feasible alternative associated with favorable clinical outcomes.

Leadless and Wireless Cardiac Devices: The Next Frontier in Remote Patient Monitoring.

In the last decade, advances in wireless and sensor technologies, and the implementation of telemedicine, have led to innovative digital health care for cardiac patients. Continuous monitoring of patients' biomedical signals, and acute changes in these signals, may result in timely, accurate diagnoses and implementation of early interventions. In this review, we discuss commonly used wireless and leadless cardiac devices including pulmonary artery pressure sensors, implantable loop recorders, leadless pacemakers and subcutaneous implantable cardioverter-defibrillators. We discuss the concept and function of each device, indications, methods of delivery, potential complications, consideration for implantation, and cost-effectiveness.

Mortalidade e causas de óbitos nas prisões do Rio de Janeiro, Brasil / Mortality and causes of deaths in prisons in Rio de Janeiro, Brazil / Mortalidad y causas de óbitos en las prisiones de Río de Janeiro, Brasil

Resumo: A mortalidade nas prisões, indicador fundamental do direito à saúde das pessoas privadas de liberdade (PPL), nunca foi estudada de maneira aprofundada no Brasil. A avaliação da mortalidade global e por causas entre PPL encarceradas em 2016-2017 no Estado do Rio de Janeiro, foi realizada a partir de dados do Sistema de Informações sobre Mortalidade e da Administração Penitenciária. Taxas de mortalidade entre PPL e população geral do estado foram comparadas após padronização. As principais causas de morte entre PPL foram doenças infecciosas (30%), doenças do aparelho circulatório (22%) e causas externas (12%). Dentre as causas infecciosas, destacam-se HIV/aids (43%) e tuberculose (TB) (52% se considerados todos os óbitos com menção de TB). Somente 0,7% das PPL que faleceram tiveram acesso a serviço de saúde extramuros. A taxa global de mortalidade foi maior entre as PPL comparadas à população geral do estado, com mortalidade por doenças infecciosas 5 vezes superior, por TB 15 vezes e por doenças endócrinas, especialmente diabetes, e doenças circulatórias (1,5 e 1,3 vez, respectivamente), enquanto mortes por causa externa foram menos frequentes entre PPL. Este estudo mostra um expressivo excesso de mortes potencialmente evitáveis nas prisões, o que traduz importante desassistência e exclusão dessa população do Sistema Único de Saúde. Evidencia a necessidade de um sistema de monitoramento, em tempo real, dos óbitos, preciso e sustentável, além da reestruturação da saúde prisional por meio da efetivação da Política Nacional de Atenção Integral à Saúde das Pessoas Privadas de Liberdade no Sistema Prisional para que as PPL usufruam do direito constitucional à saúde em sua integralidade, com a mesma qualidade e tempestividade oferecida à população geral.

Abstract: Mortality in prisons, a basic indicator of the right to health for incarcerated persons, has never been studied extensively in Brazil. An assessment of all-cause and cause-specific mortality in prison inmates was conducted in 2016-2017 in the state of Rio de Janeiro, based on data from the Mortality Information System and Prison Administration. Mortality rates were compared between prison population and general population after standardization. The leading causes of death in inmates were infectious diseases (30%), cardiovascular diseases (22%), and external causes (12%). Infectious causes featured HIV/AIDS (43%) and TB (52%, considering all deaths with mention of TB). Only 0.7% of inmates who died had access to extramural health services. All-cause mortality rate was higher among prison inmates than in the state's general population. Among inmates, mortality from infectious diseases was 5 times higher, from TB 15 times higher, and from endocrine diseases (especially diabetes) and cardiovascular diseases 1.5 and 1.3 times higher, respectively, while deaths from external causes were less frequent in prison inmates. The study revealed important potentially avoidable excess deaths in prisons, reflecting lack of care and exclusion of this population from the Brazilian Unified National Health System. This further highlights the need for a precise and sustainable real-time monitoring system for deaths, in addition to restructuring of the prison staff through implementation of the Brazilian National Policy for Comprehensive Healthcare for Persons Deprived of Freedom in the Prison System in order for inmates to fully access their constitutional right to health with the same quality and timeliness as the general population.

Resumen: La mortalidad en las prisiones, indicador fundamental del derecho a la salud de personas privadas de libertad (PPL), nunca se estudió profundamente en Brasil. La evaluación de la mortalidad global y por causas entre PPL, encarceladas en 2016-2017 en el estado de Rio de Janeiro, se realizó a partir de datos del Sistema de Información de Mortalidad y la Administración Penitenciaria. Se compararon las tasas de mortalidad entre PPL y población general del estado tras la estandarización. Las principales causas de muerte entre PPL fueron: enfermedades infecciosas (30%), enfermedades del aparato circulatorio (22%) y causas externas (12%). Entre las causas infecciosas, se destacan VIH/sida (43%) y tuberculosis (TB) (52%, si se consideran todos los óbitos con mención TB). Solamente un 0,7% de las PPL que fallecieron tuvieron acceso a un servicio de salud extramuros. La tasa global de mortalidad fue mayor entre las PPL, comparada con la población general del estado. Entre las PPL, la mortalidad por enfermedades infecciosas fue 5 veces superior, por TB 15 veces, y por enfermedades endocrinas, especialmente diabetes, y enfermedades circulatorias (1,5 y 1,3 veces respectivamente), mientras que las muertes por causa externa fueron menos frecuentes entre PPLs. Este estudio muestra un expresivo exceso de muertes potencialmente evitables en las prisiones, lo que se traduce en una importante desasistencia y la exclusión de esta población del Sistema Único de Salud. Pone en evidencia la necesidad de un sistema de supervisión en tiempo real de los óbitos, preciso y sostenible, además de la reestructuración de la salud en las prisiones, mediante la efectivización de la Política Nacional de Atención Integral a la Salud de las Personas Privadas de Libertad en el Sistema Penitenciario para que las PPLs disfruten del derecho constitucional a la salud en su integridad, con la misma calidad y oportunidad ofrecida a la población general.

Central sleep apnea and atrial fibrillation: A review on pathophysiological mechanisms and therapeutic implications.

Precipitating factors and chronic diseases associated with atrial fibrillation (AF) are detailed in the literature. Emerging evidence over the last several decades suggests a potential causal relationship between central sleep apnea (CSA) and AF. Mechanisms including apnea-induced hypoxia with intermittent arousal, fluctuating levels of carbon dioxide, enhanced sympathetic/neurohormonal activation and oxidative stress causing inflammation have been implicated as etiologic causes of AF within this subpopulation. CSA affects the efficacy of pharmacologic and catheter-based antiarrhythmic treatments, which is why treating CSA prior to these interventions may lead to lower rates of AF. Subsequently, a reduction in the AF burden with transvenous phrenic nerve stimulation (TPNS) has become a topic of interest. The present review describes the relationship between these conditions, pathophysiologic mechanisms implicating the role of CSA in development of AF, and emerging therapeutic interventions.