Artificial intelligence and discrete-event simulation for capacity management of intensive care units during the Covid-19 pandemic: A case study.

The Covid-19 pandemic has pushed the Intensive Care Units (ICUs) into significant operational disruptions. The rapid evolution of this disease, the bed capacity constraints, the wide variety of patient profiles, and the imbalances within health supply chains still represent a challenge for policymakers. This paper aims to use Artificial Intelligence (AI) and Discrete-Event Simulation (DES) to support ICU bed capacity management during Covid-19. The proposed approach was validated in a Spanish hospital chain where we initially identified the predictors of ICU admission in Covid-19 patients. Second, we applied Random Forest (RF) to predict ICU admission likelihood using patient data collected in the Emergency Department (ED). Finally, we included the RF outcomes in a DES model to assist decision-makers in evaluating new ICU bed configurations responding to the patient transfer expected from downstream services. The results evidenced that the median bed waiting time declined between 32.42 and 48.03 min after intervention.

Amenable Mortality in Children under 5: An Indicator for Identifying Inequalities in Healthcare Delivery: A Review.

Universal health coverage has been proposed as a strategy to improve health in low- and middle-income countries, but this depends on a good provision of health services. Under-5 mortality (U5M) reflects the quality of health services, and its reduction has been a milestone in modern society, reducing global mortality rates by more than two-thirds between 1990 and 2020. However, despite these impressive achievements, they are still insufficient, and most deaths in children under 5 can be prevented with the provision of timely and high-quality health services. The aim of this paper is to conduct a literature review on amenable (treatable) mortality in children under 5. This indicator is based on the concept that deaths from certain causes should not occur in the presence of timely and effective medical care. A systematic and exhaustive review of available literature on amenable mortality in children under 5 was conducted using MEDLINE/PubMed, Cochrane CENTRAL, OVID medline, Scielo, Epistemonikos, ScienceDirect, and Google Scholar in both English and Spanish. Both primary sources, such as scientific articles, and secondary sources, such as bibliographic indices, websites, and databases, were used. Results: The main cause of amenable mortality in children under 5 was respiratory disease, and the highest proportion of deaths occurred in the perinatal period. Approximately 65% of avoidable deaths in children under 5 were due to amenable mortality, that is, due to insufficient quality in the provision of health services. Most deaths in all countries and around the world are preventable, primarily through effective and timely access to healthcare (amenable mortality) and the management of public health programs focused on mothers and children (preventable mortality).

Evolutionary Echoes: A Four-Day Fasting and Low-Caloric Intake Study on Autonomic Modulation and Physiological Adaptations in Humans.

This study evaluates the psychophysiological response to a simulated hunter-gatherer endurance task with restricted caloric intake over four days. It assesses changes in body composition, autonomic modulation, and physical and cognitive performance. Participants underwent daily 8 h fasted walks followed by a 150 kcal meal to replicate hunter-gatherer activity and dietary patterns. Measurements of metabolic, respiratory, and subjective well-being, along with heart rate variability (HRV) monitoring, were conducted pre- and post-activity to evaluate the impact of endurance activity under caloric restriction. We found weight loss, decreased body and visceral fat, and reduced skeletal muscle mass and water percentage. High sympathetic activation and stable urinary markers, except for increased proteinuria, indicated stress responses and muscular degradation. Elevated perceived exertion post-exercise with good adaptation to prolonged effort underlines the body's adaptability to ancestral lifestyle conditions, highlighting the connection among endurance, nutrition, and psychophysiological health.

Application of Functional Neurology Therapy in a Lactose-Intolerant Patient.

This case report examines the impact of a single session of functional neurology on a 35-year-old female patient diagnosed with lactose intolerance. The patient presented with severe gastrointestinal symptoms, including frequent diarrhea, bloating, and vomiting upon dairy consumption. The intervention aimed to reset dysfunctional neurological programs believed to contribute to her condition. The study utilized a standardized lactose intolerance breath test to measure the hydrogen and methane levels at various intervals before and after treatment. Post-treatment results showed symptomatic relief with the patient reporting normalized bowel movements and the absence of previous symptoms. Despite these improvements, the biochemical markers at higher time points (150 and 175 min) post-treatment remained similar to the pre-treatment values, indicating persistent lactose malabsorption and highlighting the variability of hydrogen measurements. This case report suggests that a single session of functional neurology can significantly alleviate the symptoms of lactose intolerance. However, the preliminary nature of these results underscores the need for further research involving larger sample sizes and long-term follow-up to fully understand the treatment's efficacy and underlying mechanisms.

Nutritional Modulation of the Gut-Brain Axis: A Comprehensive Review of Dietary Interventions in Depression and Anxiety Management.

Mental health is an increasing topic of focus since more than 500 million people in the world suffer from depression and anxiety. In this multifactorial disorder, parameters such as inflammation, the state of the microbiota and, therefore, the patient's nutrition are receiving more attention. In addition, food products are the source of many essential ingredients involved in the regulation of mental processes, including amino acids, neurotransmitters, vitamins, and others. For this reason, this narrative review was carried out with the aim of analyzing the role of nutrition in depression and anxiety disorders. To reach the review aim, a critical review was conducted utilizing both primary sources, such as scientific publications and secondary sources, such as bibliographic indexes, web pages, and databases. The search was conducted in PsychINFO, MedLine (Pubmed), Cochrane (Wiley), Embase, and CinAhl. The results show a direct relationship between what we eat and the state of our nervous system. The gut-brain axis is a complex system in which the intestinal microbiota communicates directly with our nervous system and provides it with neurotransmitters for its proper functioning. An imbalance in our microbiota due to poor nutrition will cause an inflammatory response that, if sustained over time and together with other factors, can lead to disorders such as anxiety and depression. Changes in the functions of the microbiota-gut-brain axis have been linked to several mental disorders. It is believed that the modulation of the microbiome composition may be an effective strategy for a new treatment of these disorders. Modifications in nutritional behaviors and the use of ergogenic components are presented as important non-pharmacological interventions in anxiety and depression prevention and treatment. It is desirable that the choice of nutritional and probiotic treatment in individual patients be based on the results of appropriate biochemical and microbiological tests.

Sporting Mind: The Interplay of Physical Activity and Psychological Health.

The symbiotic relationship between sports practice and psychological well-being has, in recent times, surged to the forefront of academic and public attention. The aim of this narrative review is to comprehensively explore the intricate pathways linking physical engagement in sports to its subsequent impacts on mental health and synthesize the multifarious effects of sports on psychological health, offering insights for integrating physical and psychological strategies to enhance well-being. From neurobiological underpinnings to therapeutic applications, this comprehensive manuscript provides an in-depth dive into the multifaceted world of sports and psychology. Highlighting evidence-based interventions, this review aspires to offer actionable insights for practitioners, athletes, and individuals alike, advocating for a holistic approach to mental well-being. This manuscript highlights the profound impact of sports on mental health, emphasizing its role in emotional regulation, resilience, cognitive function, and treating psychological conditions. It details how sports induce neurochemical changes, enhance brain functions like memory and learning, and aid against cognitive decline. This review also notes the benefits of regular exercise in mood improvement, stress management, and social skill enhancement, particularly when combined with mindfulness practices. It underscores the importance of considering cultural and gender perspectives in sports psychology, advocating for an integrated physical-psychological approach to promote overall well-being.

Metabolic Health, Mitochondrial Fitness, Physical Activity, and Cancer.

Cancer continues to be a significant global health issue. Traditional genetic-based approaches to understanding and treating cancer have had limited success. Researchers are increasingly exploring the impact of the environment, specifically inflammation and metabolism, on cancer development. Examining the role of mitochondria in this context is crucial for understanding the connections between metabolic health, physical activity, and cancer. This study aimed to review the literature on this topic through a comprehensive narrative review of various databases including MedLine (PubMed), Cochrane (Wiley), Embase, PsychINFO, and CinAhl. The review highlighted the importance of mitochondrial function in overall health and in regulating key events in cancer development, such as apoptosis. The concept of "mitochondrial fitness" emphasizes the crucial role of mitochondria in cell metabolism, particularly their oxidative functions, and how proper function can prevent replication errors and regulate apoptosis. Engaging in high-energy-demanding movement, such as exercise, is a powerful intervention for improving mitochondrial function and increasing resistance to environmental stressors. These findings support the significance of considering the role of the environment, specifically inflammation and metabolism, in cancer development and treatment. Further research is required to fully understand the mechanisms by which physical activity improves mitochondrial function and potentially reduces the risk of cancer.

Social Media, Anxiety and COVID-19 Lockdown Measurement Compliance.

The aim of the present research was to analyze the effect of anxiety levels during the COVID-19 pandemic in the use of social media and compliance with lockdown measures during the confinement. A total of 1723 participants (32.1% males and 77.9% females; 32.6 ± 9.2 years) were interviewed by a Spanish version of the Spielberger State-Trait Anxiety Inventory. From the results obtained, the sample was divided into two 50th percentile groups, a high anxiety group (HAG) and a low anxiety group (LAG). We found how the LAG had lower use of social networks such as Facebook and Twitter during confinement. Also, this group presented a higher rate of leaving home during the confinement and higher values in people with whom they had lived with during confinement than high anxiety group. Regardless of the lack of results in the remaining variables, the present study nuances the high levels of anxiety experienced during COVID-19 confinement. The multifactorial analysis of factors related to the perception of anxiety during COVID-19 confinement may be a useful tool to measure multiple social behaviors when examining mental health factors. Thus, explaining and preventing the psychological consequences of the COVID-19 pandemic. The present knowledge could be used to determine key intervention factors for reducing the perception of fear and anxiety.

The Role of Adipokines in Health and Disease.

Adipokines are cell-signaling proteins secreted by adipose tissue that has been related to a low-grade state of inflammation and different pathologies. The present review aims to analyze the role of adipokines in health and disease in order to understand the important functions and effects of these cytokines. For this aim, the present review delves into the type of adipocytes and the cytokines produced, as well as their functions; the relations of adipokines in inflammation and different diseases such as cardiovascular, atherosclerosis, mental diseases, metabolic disorders, cancer, and eating behaviors; and finally, the role of microbiota, nutrition, and physical activity in adipokines is discussed. This information would allow for a better understanding of these important cytokines and their effects on body organisms.

The Impact of Anorexia Nervosa and the Basis for Non-Pharmacological Interventions.

Anorexia nervosa is a psychiatric disorder with an unknown etiology that is characterized by an individual's preoccupation with their weight and body structure while denying the severity of their low body weight. Due to the fact that anorexia nervosa is multifaceted and may indicate the coexistence of genetic, social, hormonal, and psychiatric disorders, a description of non-pharmacological interventions can be used to ameliorate or reduce the symptoms of this condition. Consequently, the purpose of the present narrative review is to describe the profile's context in the anorexic person as well as the support they would require from their family and environment. In addition, it is aimed at examining preventative and non-pharmacological interventions, such as nutritional interventions, physical activity interventions, psychological interventions, psychosocial interventions, and physical therapy interventions. To reach the narrative review aims, a critical review was conducted utilizing both primary sources, such as scientific publications, and secondary sources, such as bibliographic indexes, web pages, and databases. Nutritional interventions include nutritional education and an individualized treatment for each patient, physical activity interventions include allowing patients to perform controlled physical activity, psychological interventions include family therapy and evaluation of the existence of other psychological disorders, psychosocial interventions include management of the relationship between the patient and social media and physical therapy interventions include relaxation massages and exercises to relieve pain. All these non-pharmacological interventions need to be individualized based on each patient's needs.

Basis of preventive and non-pharmacological interventions in asthma.

Asthma is one of the most common atopic disorders in all stages of life. Its etiology is likely due to a complex interaction between genetic, environmental, and lifestyle factors. Due to this, different non-pharmacological interventions can be implemented to reduce or alleviate the symptoms caused by this disease. Thus, the present narrative review aimed to analyze the preventive and non-pharmacological interventions such as physical exercise, physiotherapy, nutritional, ergonutritional, and psychological strategies in asthma treatment. To reach these aims, an extensive narrative review was conducted. The databases used were MedLine (PubMed), Cochrane (Wiley), Embase, PsychINFO, and CinAhl. Asthma is an immune-mediated inflammatory condition characterized by increased responsiveness to bronchoconstrictor stimuli. Different factors have been shown to play an important role in the pathogenesis of asthma, however, the treatments used to reduce its incidence are more controversial. Physical activity is focused on the benefits that aerobic training can provide, while physiotherapy interventions recommend breathing exercises to improve the quality of life of patients. Nutritional interventions are targeted on implement diets that prioritize the consumption of fruits and vegetables and supplementation with antioxidants. Psychological interventions have been proposed as an essential non-pharmacological tool to reduce the emotional problems associated with asthma.

Behavioral Patterns of Depression Patients and Control Population.

Behavioral and multifactorial factors, such as psychological, nutritional, dental pathology, and physical activity habits, are factors that control depression. The objective of the present study was to analyze the differences in the behavioral, psychological, nutritional, dental pathology, and physical activity patterns of the depressed and control population. Forty-eight participants with depression (45.7 ± 12.0) and one hundred participants in a control group without any pathology or medication (48.9 ± 7.9) were interviewed using an online questionnaire. The multifactorial items of psychology, oral behavior, nutritional habits, and physical activity profile were analyzed through a set of questionnaires. The results showed how the depression group showed significantly higher psychological measures related to personality, anxiety, depression, loneliness, perceived stress, and psychological inflexibility than the control group. The control group showed significantly higher weekly vitality, vitality at the end of the week, weekly frequency of juice, wine, coffee, fresh vegetable salad, and Bristol scale than the depression group. Higher values of migraine headache, weekly soft drink frequency, and digestion after meals were found in the depression group. In addition, patients with depression also presented poor dental health, presenting higher rates of gastritis or heartburn, dry mouth, dental sensitivity, and sick days per year than the control group. Both groups presented a pattern of low physical activity. This information allows a better understanding of a multifactorial disease, as well as the creation of intervention and prevention protocols for this disease at a behavioral and lifestyle level.

A fuzzy hybrid decision-making framework for increasing the hospital disaster preparedness: The colombian case.

The recent increase in the number of disasters over the world has once again brought to the agenda the question of preparedness of the hospitals, which are the most necessary units of healthcare pillar to resist these disasters. The COVID-19 epidemic disease, which has affected the whole world, has caused a large number of people to die in some countries simply because of the inadequate and incomplete planning and lack of readiness of hospitals. For this reason, determining the disaster preparedness level of hospitals is an important issue that needs to be studied and it is important in terms of disaster damage reduction. In this study, a fuzzy hybrid decision-making framework is proposed to assess hospital disaster preparedness. The framework covers three important decision-making methods. For the first phase, Intuitionistic Fuzzy Analytic Hierarchy Process (IF-AHP) is used to assign relative weights for several disaster preparedness criteria considering uncertainty. Secondly, Intuitionistic Fuzzy Decision Making Trial and Evaluation Laboratory (IF-DEMATEL) is applied to identify interrelations among these criteria and feedback. Finally, via the VlseKriterijumska Optimizacija I Kompromisno Resenje (VIKOR) method, priorities of hospitals regarding disaster readiness are obtained. A case study involving the participation of 10 Colombian tertiary hospitals is carried out to show the applicability of this fuzzy hybrid approach.

Infancy Dietary Patterns, Development, and Health: An Extensive Narrative Review.

Correct dietary patterns are important for a child's health from birth to adulthood. Understanding a child's health as a state of entire physical, mental, and social well-being is essential. However, reaching adulthood in a complete health proper state is determined by feeding and dietary habits during preconception, pregnancy, or children infancy. Different factors, such as the mother's lifestyle, culture, or socioeconomic status, are crucial during all these phases. In this review, we aimed to assess the long-term associations between infancy dietary patterns and health and their influence on development and growth. To reach this objective, a consensus critical review was carried out using primary sources such as scientific articles, and secondary bibliographic indexes, databases, and web pages. PubMed, SciELO, and Google Scholar were the tools used to complete this research. We found that high-income countries promote high-calorie foods and, consequently, obesity problems among children are rising. However, undernutrition is a global health issue concerning children in low- and middle-income countries; thus, parental socioeconomic status in early life is essential to children's health and development, showing that biological, social, and environmental influences are increased risk factors for chronic diseases. This narrative review is aimed to collect evidence for early nutritional intervention and future disease prevention.

Nutritional and Exercise Interventions in Cancer-Related Cachexia: An Extensive Narrative Review.

One of the common traits found in cancer patients is malnutrition and cachexia, which affects between 25% to 60% of the patients, depending on the type of cancer, diagnosis, and treatment. Given the lack of current effective pharmacological solutions for low muscle mass and sarcopenia, holistic interventions are essential to patient care, as well as exercise and nutrition. Thus, the present narrative review aimed to analyze the nutritional, pharmacological, ergonutritional, and physical exercise strategies in cancer-related cachexia. The integration of multidisciplinary interventions could help to improve the final intervention in patients, improving their prognosis, quality of life, and life expectancy. To reach these aims, an extensive narrative review was conducted. The databases used were MedLine (PubMed), Cochrane (Wiley), Embase, PsychINFO, and CinAhl. Cancer-related cachexia is a complex multifactorial phenomenon in which systemic inflammation plays a key role in the development and maintenance of the symptomatology. Pharmacological interventions seem to produce a positive effect on inflammatory state and cachexia. Nutritional interventions are focused on a high-energy diet with high-density foods and the supplementation with antioxidants, while physical activity is focused on strength-based training. The implementation of multidisciplinary non-pharmacological interventions in cancer-related cachexia could be an important tool to improve traditional treatments and improve patients' quality of life.

Mis-Dis Information in COVID-19 Health Crisis: A Narrative Review.

BACKGROUND: In this narrative review, we address the COVID-19 pandemic mis-dis information crisis in which healthcare systems have been pushed to their limits, with collapses occurring worldwide. The context of uncertainty has resulted in skepticism, confusion, and general malaise among the population. Informing the public has been one of the major challenges during this pandemic. Misinformation is defined as false information shared by people who have no intention of misleading others. Disinformation is defined as false information deliberately created and disseminated with malicious intentions. OBJECTIVE: To reach a consensus and critical review about mis-dis information in COVID-19 crisis. METHODS: A database search was conducted in PsychINFO, MedLine (Pubmed), Cochrane (Wiley), Embase and CinAhl. Databases used the MeSH-compliant keywords of COVID-19, 2019-nCoV, Coronavirus 2019, SARS-CoV-2, misinformation, disinformation, information, vaccines, vaccination, origin, target, spread, communication. RESULTS: Both misinformation and disinformation can affect the population's confidence in vaccines (development, safety, and efficacy of vaccines, as well as denial of the severity of SARS-CoV infection). Institutions should take into account that a great part of the success of the intervention to combat a pandemic has a relationship with the power to stop the misinformation and disinformation processes. The response should be well-structured and addressed from different key points: central level and community level, with official and centralized communication channels. The approach should be multifactorial and enhanced by the collaboration of social media companies to stop misleading information, and trustworthy people both working or not working in the health care systems to boost the power of the message. CONCLUSIONS: The response should be well-structured and addressed from different key points: central level and community level, with official and clearly centralized communication channels. The approach should be multifactorial and enhanced from the collaboration of social media companies to stop misleading information, and trustworthy people both working and not working in the health care systems to boost the power of a message based on scientific evidence.

Performance of Fuzzy Multi-Criteria Decision Analysis of Emergency System in COVID-19 Pandemic. An Extensive Narrative Review.

The actual coronavirus disease 2019 (COVID-19) pandemic has led to the limit of emergency systems worldwide, leading to the collapse of health systems, police, first responders, as well as other areas. Various ways of dealing with this world crisis have been proposed from many aspects, with fuzzy multi-criteria decision analysis being a method that can be applied to a wide range of emergency systems and professional groups, aiming to confront several associated issues and challenges. The purpose of this critical review was to discuss the basic principles, present current applications during the first pandemic wave, and propose future implications of this methodology. For this purpose, both primary sources, such as scientific articles, and secondary ones, such as bibliographic indexes, web pages, and databases, were used. The main search engines were PubMed, SciELO, and Google Scholar. The method was a systematic literature review of the available literature regarding the performance of the fuzzy multi-criteria decision analysis of emergency systems in the COVID-19 pandemic. The results of this study highlight the importance of the fuzzy multi-criteria decision analysis method as a beneficial tool for healthcare workers and first responders' emergency professionals to face this pandemic as well as to manage the created uncertainty and its related risks.

The Impact of the COVID-19 Pandemic on Mental Disorders. A Critical Review.

The COVID-19 pandemic has impacted the lives of the worldwide population. Citizens suffer the social, economic, physiological, and psychological effects of this pandemic. Primary sources, scientific articles, and secondary bibliographic indexes, databases, and web pages were used for a consensus critical review. The method was a narrative review of the available literature to summarize the existing literature addressing mental health concerns and stressors related to the COVID-19 pandemic. The main search engines used in the present research were PubMed, SciELO, and Google Scholar. We found the pandemic has had a direct impact on psychopathologies such as anxiety, increasing its ratios, and depression. Other syndromes such as burnout and post-traumatic stress disorder have increased with the pandemic, showing a larger incidence among medical personnel. Moreover, eating disorders and violence have also increased. Public authorities must prepare healthcare systems for increasing incidences of mental pathologies. Mental health apps are one of the tools that can be used to reach the general population.

Evaluation of hospital disaster preparedness by a multi-criteria decision making approach: The case of Turkish hospitals.

Considering the unexpected emergence of natural and man-made disasters over the world and Turkey, the importance of preparedness of hospitals, which are the first reference points for people to get healthcare services, becomes clear. Determining the level of disaster preparedness of hospitals is an important and necessary issue. This is because identifying hospitals with low level of preparedness is crucial for disaster preparedness planning. In this study, a hybrid fuzzy decision making model was proposed to evaluate the disaster preparedness of hospitals. This model was developed using fuzzy analytic hierarchy process (FAHP)-fuzzy decision making trial and evaluation laboratory (FDEMATEL)-technique for order preference by similarity to ideal solutions (TOPSIS) techniques and aimed to determine a ranking for hospital disaster preparedness. FAHP is used to determine weights of six main criteria (including hospital buildings, equipment, communication, transportation, personnel, flexibility) and a total of thirty-six sub-criteria regarding disaster preparedness. At the same time, FDEMATEL is applied to uncover the interdependence between criteria and sub-criteria. Finally, TOPSIS is used to obtain ranking of hospitals. To provide inputs for TOPSIS implementation, some key performance indicators are established and related data is gathered by the aid of experts from the assessed hospitals. A case study considering 4 hospitals from the Turkish healthcare sector was used to demonstrate the proposed approach. The results evidenced that Personnel is the most important factor (global weight = 0.280) when evaluating the hospital preparedness while Flexibility has the greatest prominence (c + r = 23.09).

Implementation of clinical practice guidelines for the timely detection and diagnosis of eating disorders in adolescents and adults in the outpatient and priority department of a public psychiatric hospital in Colombia. / Implementación de una guía de práctica clínica para la detección oportuna y el diagnóstico de trastornos de la conducta alimentaria en adolescentes y adultos en el servicio de consulta externa y prioritaria de un hospital mental público de Colombia.

OBJECTIVE: To implement clinical practice guidelines (CPGs) for the timely detection and diagnosis of eating disorders in adolescents and adults in the priority outpatient department of a public psychiatric hospital in Barranquilla, Colombia. Barriers to access to the implemented guidelines were identified. METHODS: For the identification of evidence-based CPGs to be implemented, systematic searches were carried out in international databases of development agencies or compilers of clinical practice guidelines, and in databases that contained scientific literature on issues related to eating disorders. CONCLUSIONS: The two guidelines shortlisted for the final selection by consensus of a multidisciplinary team at the hospital were the "Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the treatment of eating disorders" and the "Guía de práctica clínica sobre trastornos de la conducta alimentaria de Catalunya", the latter being finally chosen by consensus. There are not yet CPGs implemented for health professionals in the priority outpatient department of Colombian hospitals for eating disorders.