The Psychosocial Impact of Atopic Dermatitis.

Atopic dermatitis is a chronic skin condition that has significant psychosocial and quality-of-life impact. The condition causes physical discomfort, emotional distress, embarrassment, social stigma, and daily activity limitation. In an effort to assess these aspects of disease burden, quality-of-life measurement tools were developed. Through use of these tools, we have expanded our knowledge of the psychosocial and quality-of-life burden of this condition. A variety of quality of assessment tools exist, yet there is no consensus on which tool is best suited to assess the quality-of-life impact of atopic dermatitis. Research studies assessing quality-of-life in atopic dermatitis patients utilize a variety of quality-of-life measurement tools; this complicates comparisons across research studies. Though comparison across studies is difficult, the data echoes tremendous overall burden of disease, especially pertaining to psychosocial status and life quality.

Prototype of Low-Cost Microvascular Clips for Laboratory Use.

BACKGROUND: Vascular neurosurgical procedures require temporary or permanent surgical clips to treat cerebral aneurysms, arteriovenous malformations, or bypass surgery. In this scenario, surgical clips should have specific characteristics such as high-quality material, proper design, closing force, and biocompatibility. Due to these characteristics, the price of these clips does not allow their availability at the experimental surgery laboratory worldwide. METHODS: We describe here the technique for manufacturing handcrafted clips of low cost, using dental stainless steel or titanium wire of 0.18 mm, 0.20 mm, or 0.22 mm in diameter. We must complete six steps to obtain the clip using our hands and small electrician needle nose pliers for wire molding. RESULTS: These clips have a closing force of 30-60 gr/cm2 (depending on the wire diameter). They can be used in the experimental surgery laboratory to clip arteries or veins during vascular microsurgery procedures. Also, they can be used as temporary clips with confidence in low-flow bypass (v.gr. superficial temporal artery to middle cerebral artery or occipital artery to posterior inferior cerebellar artery anastomoses). CONCLUSIONS: Making practical low-cost clips for use in laboratory procedures or during low-flow anastomosis as temporary clips is possible. The main advantages are the low cost and the worldwide availability of the basic materials. The main disadvantage is the learning curve to get the ability to master the manufacturing of these clips.

Trade, uneven development and people in motion: Used territories and the initial spread of COVID-19 in Mesoamerica and the Caribbean.

Mesoamerica and the Caribbean form a region comprised by middle- and low-income countries affected by the COVID-19 pandemic differently. Here, we ask whether the spread of COVID-19, measured using early epidemic growth rates (r), reproduction numbers (R t ), accumulated cases, and deaths, is influenced by how the 'used territories' across the regions have been differently shaped by uneven development, human movement and trade differences. Using an econometric approach, we found that trade openness increased cases and deaths, while the number of international cities connected at main airports increased r, cases and deaths. Similarly, increases in concentration of imports, a sign of uneven development, coincided with increases in early epidemic growth and deaths. These results suggest that countries whose used territory was defined by a less uneven development were less likely to show exacerbated COVID-19 patterns of transmission. Health outcomes were worst in more trade-dependent countries, even after controlling for the impact of transmission prevention and mitigation policies, highlighting how structural effects of economic integration in used territories were associated with the initial COVID-19 spread in Mesoamerica and the Caribbean.

Home Monitoring System for Comprehensive Geriatric Assessment in Patient's Dwelling: System Design and UX Evaluation.

Population aging threatens the sustainability of welfare systems since it is not accompanied by an extended healthy and independent period in the last years of life. The Comprehensive Geriatric Assessment (CGA) has been shown to be efficient in maintaining the healthy period at the end of the life. Frailty monitoring is typically carried out for an average period of 6 months in clinical settings, while more regular monitoring could prevent the transition to disability. We present the design process of a system for frailty home monitoring based on an adapted CGA and the rationale behind its User eXperience (UX) design. The resulting home monitoring system consists of two devices based on ultrasound sensors, a weight scale, and a mobile application for managing the devices, administering CGA-related questionnaires, and providing alerts. Older users may encounter barriers in their usage of technology. For this reason, usability and acceptability are critical for health monitoring systems addressed to geriatric patients. In the design of our system, we have followed a user-centered process, involving geriatricians and older frail patients by means of co-creation methods. In the iterative process of design and usability testing, we have identified the most effective way of conducting the home-based CGA, not just by replicating the dialogue between the physician and the patient, but by adapting the design to the possibilities and limitations of mobile health for this segment of users. The usability evaluation, carried out with 14 older adults, has proved the feasibility of users older than 70 effectively using our monitoring system, additionally showing an intention over 80% for using the system. It has also provided some insights and recommendations for the design of mobile health systems for older users.

Unobtrusive Sensors for the Assessment of Older Adult's Frailty: A Scoping Review.

Ubiquity (devices becoming part of the context) and transparency (devices not interfering with daily activities) are very significant in healthcare monitoring applications for elders. The present study undertakes a scoping review to map the literature on sensor-based unobtrusive monitoring of older adults' frailty. We aim to determine what types of devices comply with unobtrusiveness requirements, which frailty markers have been unobtrusively assessed, which unsupervised devices have been tested, the relationships between sensor outcomes and frailty markers, and which devices can assess multiple markers. SCOPUS, PUBMED, and Web of Science were used to identify papers published 2010-2020. We selected 67 documents involving non-hospitalized older adults (65+ y.o.) and assessing frailty level or some specific frailty-marker with some sensor. Among the nine types of body worn sensors, only inertial measurement units (IMUs) on the waist and wrist-worn sensors comply with ubiquity. The former can transparently assess all variables but weight loss. Wrist-worn devices have not been tested in unsupervised conditions. Unsupervised presence detectors can predict frailty, slowness, performance, and physical activity. Waist IMUs and presence detectors are the most promising candidates for unobtrusive and unsupervised monitoring of frailty. Further research is necessary to give specific predictions of frailty level with unsupervised waist IMUs.

PRAME immunohistochemistry as an adjunct for diagnosis and histological margin assessment in lentigo maligna.

AIMS: Lentigo maligna (LM), the most common type of melanoma in situ, is a diagnostically challenging lesion for pathologists due to abundant background melanocytic hyperplasia in sun-damaged skin. Currently, no laboratory methods reliably distinguish benign from malignant melanocytes. However, preferentially expressed antigen in melanoma (PRAME) has shown promise in this regard, and could potentially be applied to diagnosis and margin assessment in difficult cases of LM. METHODS AND RESULTS: Ninety-six cases with a diagnosis of LM (n = 77) or no residual LM (n = 19) following initial biopsy were identified and stained with an antibody directed towards PRAME. Immunohistochemistry (IHC) was scored as positive or negative, and measurement of histological margins by PRAME was performed and compared to the measurement of histological margins using conventional methods [haematoxylin and eosin (H&E) and/or sex-determining region Y-box 10 (SOX10) and/or Melan-A]. Of cases with LM, 93.5% (72 of 77) were PRAME+ and 94.7% (18 of 19) of cases with no residual LM were PRAME- . Of the 35 cases with no margin involvement by PRAME or conventional assessment, 14 cases (40.0%) had no difference in measurement, 17 (48.6%) had a difference of 1 mm or less and four (11.4%) differed by between 1 and 3.5 mm. There was a high correlation between margin assessment methods (r = 0.97, P < 0.0001). CONCLUSIONS: PRAME IHC is a sensitive (93.5%) and specific (94.7%) method for diagnosing LM on biopsy and excision, and measurement of histological margins by PRAME shows a high correlation with conventional methods for margin assessment. Furthermore, the nuclear expression of PRAME makes it a good target for use in dual-colour IHC stains.

Health policy impacts on malaria transmission in Costa Rica.

Costa Rica is near malaria elimination. This achievement has followed shifts in malaria health policy. Here, we evaluate the impacts that different health policies have had on malaria transmission in Costa Rica from 1913 to 2018. We identified regime shifts and used regression models to measure the impact of different health policies on malaria transmission in Costa Rica using annual case records. We found that vector control and prophylactic treatments were associated with a 50% malaria case reduction in 1929-1931 compared with 1913-1928. DDT introduction in 1946 was associated with an increase in annual malaria case reduction from 7.6% (1942-1946) to 26.4% (1947-1952). The 2006 introduction of 7-day supervised chloroquine and primaquine treatments was the most effective health policy between 1957 and 2018, reducing annual malaria cases by 98% (2009-2018) when compared with 1957-1968. We also found that effective malaria reduction policies have been sensitive to natural catastrophes and extreme climatic events, both of which have increased malaria transmission in Costa Rica. Currently, outbreaks follow malaria importation into vulnerable areas of Costa Rica. This highlights the need to timely diagnose and treat malaria, while improving living standards, in the affected areas.

Objective motor assessment for personalized rehabilitation of upper extremity in brain injury patients.

BACKGROUND: The increasing number of patients with acquired brain injury and the current subjectivity of the conventional upper extremity (UE) assessment tests require new objective assessment techniques. OBJECTIVE: This research proposes a novel objective motor assessment (OMA) methodology based on the Fugl-Meyer assessment (FMA). The goals are to automatically calculate the objective scores (OSs) of FMA-UE movements (as well as a global OS) and to interpret the estimated OSs. METHODS: Fifteen patients participated in the study. The OMA algorithm was designed to detect small-scale variations in UE movements. The OSs for 14 FMA-UE movements and the global OSs were automatically calculated using the algorithm and evaluated by 2 therapists. The interpretation of the global OSs was performed at 3 levels: by item, movement and globally. RESULTS: The global OSs calculated by our algorithm had a significant correlation with the therapists' scores (0.783 and 0.938, p <  0.01). All OSs for each movement were correlated with the scores given by the therapists. The correlation coefficient can reach values as high as 0.981 (p <  0.01). CONCLUSIONS: We provide a new objective assessment tool for therapists to help them improve the diagnostic accuracy and to achieve a more personalized and potentially effective physical rehabilitation of brain injury patients.

Análisis de inclusión social de población afro-descendiente en centros de práctica de medicina ancestral (Kilombos) en Bogotá / Analysis of social inclusion of Afro-descendant population in ancestral medicine practice centers (Kilombos) in Bogotá

En este estudio hace énfasis en el papel de la inclusión social y la medicina tradicional de la comunidad afrodescendiente en relación con el programa de medicina intercultural en la zona centro oriente de la ciudad de Bogotá, Se examinan los principales actores sociales en los niveles individual o micro (de los participantes), interno o meso (territorios saludables medicina intercultural, entidades relacionadas con el proyecto medicina intercultural) y macro (actores institucionales, percepción institucional) sobre el rol desempeñado por las entidades encargadas de dinamizar el componente de inclusión social para grupos étnicos proyecto medicina intercultural en el periodo 2012 ­ 2016, por medio de entrevistas semiestructuradas a funcionarios del Instituto Distrital de la Participación y Acción Comunal ­ IDPAC- , Secretaria de Salud, Funcionarios de los Kilombos y un grupo focal con la participación de lideresas en la comunidad Afrodescendiente; Los datos analizados sugieren que la inclusión social en general requiere el reconocimiento de las particularidades culturales de comunidades que como la Afro, así determinan sus prácticas como ciudadanos dignos; en particular en el sector salud, se requiere el acceso opcional a los Kilombos; El abordaje cultural a la salud debe establecerse en el diálogo entre los saberes de la medicina y desde el respeto por el conocimiento y las opciones individuales.

The chilean network of microbial culture collections: establishment and operation / Red chilena de colecciones de cultivos microbianos: establecimiento y operación

According to the data available at the World Data Center for Microorganism-WDCM from the World Federation for Culture Collection-WFCC, Chile has four registered culture collections that preserve 2777 microbial strains. At the global point of view, the culture collections in Chile are in different level of operation regarding its own infrastructure and compliancy with quality standards for preservation of strains and for services provide. The absence of funding to support the preservation of the Chilean microbial assets is a key issue for the development of the Chilean bioeconomy. Considering this, the Chilean culture collections started working together to establish the Chilean Network of Microbial Culture Collections (RCCCM, acronym in Spanish). In this note, the establishment and operation of the RCCCM is presented and discussed.

De acuerdo con los datos disponibles en el World Data Center for Microorganism-WDCM de la Federación Mundial para la Colección de Cultivos - WFCC, Chile tiene cuatro colecciones de cultivos registradas que preservan 2777 cepas microbianas. Desde el punto de vista global, las colecciones de cultivos en Chile se encuentran en diferentes niveles de operación con respecto a su propia infraestructura y cumplimiento con estándares de calidad para la preservación de las cepas y para los servicios que proporcionan. La ausencia de financiamiento para apoyar la preservación de los activos microbianos chilenos es un tema clave para el desarrollo de la bioeconomía chilena. Considerando esto, las colecciones chilenas de cultivos comenzaron a trabajar conjuntamente para establecer la Red Chilena de Colecciones de Cultivos Microbianos (RCCCM). En esta nota se presenta y discute el establecimiento y funcionamiento de la RCCCM.

[Assessing the economic impact of cancer in Chile: a direct and indirect cost measurement based on 2009 registries]. / Impacto económico del cáncer en Chile: una medición de costo directo e indirecto en base a registros 2009.

PURPOSE: This paper aims to determine the economic impact that cancer represents to Chile, exploring the share of costs for the most important cancers and the differences between the public and private sector. METHODS: We used the cost of illness methodology, through the assessment of the direct and indirect costs associated with cancer treatment. Data was obtained from 2009 registries of the Chilean Ministry of Health and the Superintendence of Health. Indirect costs were calculated by days of job absenteeism and potential years of life lost. RESULTS: Over US$ 2.1 billion were spent on cancer in 2009, which represents almost 1% of Chile’s Gross Domestic Product. The direct per capita cost was US$ 47. Indirect costs were 1.92 times more than direct costs. The three types of cancer that embody the highest share of costs were gastric cancer (17.6%), breast cancer (7%) and prostate cancer (4.2%) in the public sector, and breast cancer (14%), lung cancer (7.5%) and prostate cancer (4.1%) in the private sector. On average men spent 30.33% more than women. CONCLUSION: There are few studies of this kind in Chile and the region. The country can be classified as having a cancer economic impact below the average of those in European Union countries. We expect that this information can be used to develop access policies and resource allocation decision making, and as a first step into further cancer-costing studies in Chile and the Latin American and Caribbean region.

OBJETIVO: Este trabajo pretende determinar el impacto económico del cáncer en Chile, junto con estimar la proporción del costo total atribuible a los principales tipos de cáncer y su distribución entre el sector de aseguramiento público y privado de salud. MÉTODOS: Se utilizó la metodología de costo de enfermedad, a través de la valoración de los costos directos e indirectos asociados al cáncer usando datos del Ministerio de Salud y de la Superintendencia de Salud del Chile para el año 2009. Los costos indirectos fueron calculados considerando los días de ausentismo laboral y los años de vida potencialmente perdidos. RESULTADOS: Más de 2100 millones de dólares al año es el impacto económico del cáncer en Chile, lo que representa casi el 1% del Producto Interno Bruto del país. El gasto directo per cápita fue de 47 dólares. Los costos indirectos fueron 1,92 veces mayores que los directos. Los tres tipos de cáncer de mayor impacto en los costos son: estómago (17,6%), mama (7%) y próstata (4,2%) en el sector público; y mama (14%), pulmón (7,5%) y próstata (4,1%) en el privado. Los hombres gastaron en promedio 30,33% más que las mujeres. CONCLUSIÓN: Existen pocos estudios de este tipo en Chile y la región de América Latina y El Caribe, para cáncer u otras enfermedades crónicas. El país puede ser clasificado por debajo del promedio de los costos por cáncer que muestran países de la Unión Europea. Se espera que esta información contribuya a la formulación de políticas de acceso, y que incentive más investigaciones de este tipo en Latinoamérica y El Caribe.

A First Step for the Automation of Fugl-Meyer Assessment Scale for Stroke Subjects in Upper Limb Physical Neurorehabilitation.

This paper proposes a first approach for the automation of the Fugl-Meyer assessment scale used in physical neurorehabilitation. The main goal of this research is to automatically estimate an objective measurement for five Fugl-Meyer scale items related to the assessment of the upper limb motion. An objective score has been calculated for 7 patients. Obtained results indicate that the automation of the scale can be a useful tool for the objective assessment of upper limb motion of stroke survivors.

Scalable, stereocontrolled total syntheses of (±)-axinellamines A and B.

The development of a simple, efficient, scalable, and stereocontrolled synthesis of a common intermediate en route to the axinellamines, massadines, and palau'amine is reported. This completely new route was utilized to prepare the axinellamines on a gram scale. In a more general sense, three distinct and enabling methodological advances were made during these studies: (1) an ethylene glycol-assisted Pauson-Khand cycloaddition reaction, (2) a Zn/In-mediated Barbier-type reaction, and (3) a TfNH(2)-assisted chlorination-spirocyclization.

Assessment of areas at increased risk for poliovirus circulation in Ecuador.

To assess areas at risk for poliovirus circulation in Ecuador, we first selected provinces at highest risk based on low immunization coverage with three doses of oral poliovirus vaccine, and a low number of reported cases of acute flaccid paralysis (AFP). Subsequently, we reviewed discharge data for the period 1996--2000 for diagnoses compatible with AFP in the only two national referral hospitals in Quito, and at least two main hospitals in each of the six selected provinces. Environmental samples from one or two cities/towns in each selected province were tested for poliovirus. Of the 14 identified AFP-compatible cases, 8 (57%) had been previously reported and investigated. We visited four out of the six unreported cases; none of those four had sequelae compatible with poliomyelitis. From the 14 environmental samples taken, we identified Sabin viruses in six of the samples; no vaccine-derived polioviruses were isolated. Using this methodology, we found no evidence of undetected poliovirus circulation in Ecuador.