THE RED FLAG OF EMERGENCY USE AUTHORIZATION (EUA)

The Emergency Use Authorization (EUA) policy, a representative biodefense policy, was legislated in the United States in 2001 based on lessons learned from Amerithrax, whereas Korea's EUA policy was based on lessons learned from the Middle East Respiratory Syndrome outbreak in 2015. Due to these divergent origins, the U.S. EUA's homeland security objectives were specialized to deal with highly pathogenic biological agents that could be exploited for bioterrorism, whereas the Korean EUA pursues disease containment purposes to strengthen mass-testing practices. During the early phase of the COVID-19 pandemic, the U.S. EUA revealed limitations in its integration with public health surveillance, laboratory partnerships, and insurance systems, which hampered the rapid expansion of testing capacities. Thereafter, once the limitations of the EUA were circumvented, the testing capacity of the United States began to catch up with that of South Korea, and later skyrocketed after solving these issues. (English) [ FROM AUTHOR] La política de autorización de uso de emergencia (EUA), una política representativa de biodefensa, se legisló en los Estados Unidos en 2001 en base a las lecciones aprendidas de Amerithrax, mientras que la política de EUA de Corea se basó en las lecciones aprendidas del brote del síndrome respiratorio de Oriente Medio (MERS) en 2015 Debido a estos orígenes divergentes, los objetivos de seguridad nacional de la EUA EUA se especializaron para tratar con agentes biológicos altamente patógenos que podrían explotarse para el bioterrorismo, mientras que la EUA coreana persigue propósitos de contención de enfermedades para fortalecer las prácticas de pruebas masivas. Durante la fase inicial de la pandemia de COVID-19, la EUA EUA reveló limitaciones en su integración con la vigilancia de la salud pública, las asociaciones de laboratorios y los sistemas de seguros, lo que obstaculizó la rápida expansión de las capacidades de prueba. A partir de entonces, una vez que se eludieron las limitaciones de la EUA, la capacidad de prueba de los Estados Unidos comenzó a alcanzar a la de Corea del Sur y luego se disparó después de resolver estos problemas. (Spanish) [ FROM AUTHOR] 美国在2001年根据炭疽攻击事件(Amerithrax)的经验教训制定了一项具有代表性的生物防卫政策，即紧急使用授权(EUA)政策，而韩国的EUA政策则基于2015年爆发的中东呼吸综合征(MERS)的经验教训。鉴于这些不同的起源，美国EUA的国土安全目标专门应对可能被用于生物恐怖主义的高致病性生物制剂，而韩国EUA则追求疾病遏制目的，以加强大规模检测实践。在2019冠状病毒病(COVID-19)大流行的早期阶段，美国EUA在与公共卫生监测、实验室合作伙伴关系和保险系统的整合方面存在局限性，这阻碍了检测能力的快速扩展。此后，当绕过EUA的限制后，美国的检测能力开始赶上韩国，并在解决这些问题后，检测能力直线上升。 (Chinese) [ FROM AUTHOR] Copyright of World Affairs is the property of Sage Publications Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

The Ethics of Location Tracking During the COVID-19 Pandemic and Beyond: Building Awareness and Consensus

This article highlights the relatively limited but growing discussion surrounding ethical guidelines for the use of location tracking technology. After a review of recent literature related to location data and geoprivacy, this article is divided into two sections: The first highlights views of public officials and location tracking experts over the potential misuse of location data, especially in the context of the COVID-19 pandemic. The data come from available transcripts of the Location Tech Task Force organized in 2020 by the American Geographical Society as part of its EthicalGEO initiative. The second section documents various institutional approaches to elevate the dialogue and inform governance of location-based data and technology, including the development of the Locus Charter, an emerging international framework on the ethical use of location data. In conclusion, we urge the professional and academic geographic communities to engage with the elaboration and dissemination of ethical frameworks to guide the use and management of data from location tracking technology. (English) [ FROM AUTHOR] La reciente erudición geográfica feminista ha urgido a los geógrafos a distanciarse de los enfoques androcéntricos y eurocéntricos, y a abrir la disciplina a perspectivas diversas. En tanto que numerosos estudios se han enfocado a diversificar y descolonizar la geografía por medio de prácticas de reclutamiento, tutoría y producción de conocimiento, solo muy pocos han analizado cómo se traduce la diversidad en las prácticas de enseñanza, en particular en contextos donde la diversidad está relativamente bien establecida entre el personal. Basado en una encuesta por cuestionario entre el personal docente, en un análisis del contenido de los programas de los cursos y un análisis cuantitativo de los datos de los empleados del departamento, este artículo explora hasta qué punto la diversidad dentro del departamento conduce a la diversidad en las prácticas de la enseñanza. Desarrollando un marco de los espacios de la diversidad, analizamos tres espacios que potencialmente permiten practicar la diversidad en la enseñanza: El espacio académico del departamento promueve la libre elección de los tópicos de investigación y enseñanza, y las condiciones flexibles del trabajo;el espacio del departamento permite a los individuos asumir compromisos en la configuración de la enseñanza geográfica;y el espacio del conocimiento promueve la diversidad como un ideal. Sin embargo, encontramos que practicar la diversidad en geografía implica enfrentar los retos de las estructuras universitarias tradicionales y neoliberales y de las jerarquías formales y percibidas. Aún más, existe una necesidad de prácticas concretas sobre diversidad a niveles individuales e institucionales para llevar activamente las diversas perspectivas al salón de clase. (Spanish) [ FROM AUTHOR] 女权地理学的最新研究, 敦促地理学者远离以男性和欧洲为核心的方法, 接受不同的观点。许多研究都侧重通过招聘、指导和知识生产, 去实现地理学的多样化和去殖民化。只有少数研究分析了多样性如何转化为教学实践（尤其是在教职员工多样性相对稳定的情况下）。基于教师问卷调查、课程大纲内容分析以及对地理系员工数据的定量分析, 本文探讨了地理系的多样性在多大程度上导致教学实践的多样性。我们建立了一个多样性的空间框架, 分析了可能实现教学多样性的三个空间："学术空间"促进对研究课题、课程题目和灵活工作条件的自由选择, "地理系空间"使个人能够参与地理教学的建设, "知识空间"促进理想的多样性。然而, 传统的和新自由主义的大学体系以及严格的等级制度, 是实现地理多样性的挑战。此外, 还需要在个人和体制层面采取切实的多样性实践, 积极地将不同观点带入课堂。 (Chinese) [ FROM AUTHOR] Copyright of Professional Geographer is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Academic Arena and Survival: INSIGHTS on Remote Working and Learning in Higher Education during the Recurrence of COVID-19

Introduction: Rapid outbreaks, wide spreads, and severe damage have characterized events in public health in China. Several significant challenges have faced the global community in the 21st century, including COVID-19, resulting in uncertainty about the future of current and future generations. In the wake of the COVID-19 Pandemic, remote working and learning (RWL) have gained more importance. Material and Methods: Two objectives were pursued in this study. To analyze how Higher Education Academician (HEA) and students used RWL during COVID-19 and how they handled RWL challenges. This research used a quantitative approach to achieve its objectives. A total of 480 students and 394 HEA were recruited through random sampling. Data collection was carried out using two self-developed questionnaires. Results: RWL arrangements are satisfactory to both HEA and students. HEA and students agree that RWL relieves work stress and maximizes family time. Considering the survey results, it is evident that RWL practices are strongly supported in the era of COVID-19. Conclusion: RWL is essential to work during the COVID-19 pandemic recurrence phase. It provides non-stop working and learning to HEA and students. HEA and students highly accept RWL and favor it during the particular reoccurrence period of COVID-19. Transitioning from face-to-face instruction to a fully functional virtual (RWL) environment will require time and experience. Therefore, it is recommended that the government make a proper plan for future turmoil by drawing lessons from this unanticipated crisis and providing training programs for RWL preparation. Resumen Introducción: Los acontecimientos recientes en la salud pública en China se han caracterizado por brotes rápidos, amplias propagaciones y daños graves. Varios desafíos importantes han enfrentado la comunidad global en el siglo 21, incluido COVID-19, lo que resulta en incertidumbre sobre el futuro de las generaciones actuales y futuras. A raíz de la pandemia de COVID-19, el trabajo y el aprendizaje a distancia (RWL) han ganado más importancia. Métodos: En este estudio se persiguieron dos objetivos. En primer lugar, analizar cómo el académico de educación superior (HEA) y los estudiantes usaron RWL durante COVID-19 y cómo manejaron los desafíos de RWL. Esta investigación utilizó un enfoque cuantitativo para lograr sus objetivos. Un total de 480 estudiantes y 394 HEA fueron reclutados a través de muestreo aleatorio. La recolección de datos se llevó a cabo mediante dos cuestionarios de desarrollo propio. Resultados: Los arreglos de RWL son satisfactorios tanto para HEA como para los estudiantes. Tanto HEA como los estudiantes están de acuerdo en que RWL alivia el estrés laboral y maximiza el tiempo en familia. Teniendo en cuenta los resultados de la encuesta, es evidente que las prácticas de RWL están fuertemente respaldadas en la era de COVID-19. Conclusión: RWL es esencial para trabajar durante la fase de recurrencia de la pandemia de COVID-19. Proporciona trabajo y aprendizaje sin parar a HEA y estudiantes. HEA y los estudiantes aceptan altamente RWL y la favorecen durante el período de recurrencia particular de COVID-19. La transición de la instrucción cara a cara a un entorno virtual completamente funcional (RWL) requerirá tiempo y experiencia. Por lo tanto, se recomienda que el gobierno haga un plan adecuado para la agitación futura extrayendo lecciones de esta crisis impreversa y proporcionando programas de capacitación para la preparación de RWL.

Construction and use of a risk stratification instrument for vaccination of elderly against Covid-19 / Construção e utilização de instrumento de estratificação de risco para vacinação de idosos contra a Covid-19 / Construcción y uso de un instrumento de estratificación de riesgo para la vacunación del anciano contra el Covid- 19

Objetivo: Relatar a experiência da construção e utilização de um instrumento de estratificação de risco para vacinação de idosos contra a COVID-19. Métodos: Relato da experiência desenvolvida no município de Massapê ­ Ceará, durante o ano de 2021, a partir do início da campanha de vacinação de idosos contra a COVID-19. Descrição da Experiência: Por conta da escassez de imunobiológicos, na fase inicial da vacinação contra a COVID-19, a Secretaria da Saúde do município de Massapê, estado do Ceará, criou um instrumento para estratificação de riscos sanitários, epidemiológicos e sociais dos idosos, contendo seus dados sociodemográficos e as comorbidades. Após o estabelecimento das variáveis, foram estabelecidos escores para os estratos de risco, que foram classificados em baixo (um a três pontos), médio (quatro a seis pontos), alto (sete a nove pontos) e muito alto (dez pontos e mais). Considerações Finais: O estudo mostra que, apesar da pandemia de COVID-19, uma crise sanitária global sem precedentes como já dito, ações pontuais, mesmo que localizadas, podem ter efeito em cadeia e ser replicadas em outros cenários e momentos.

Objective: To report the experience of building and using a risk stratification instrument for vaccinating the elderly against COVID-19. Methods: Report of the experience developed in the municipality of Massapê - Ceará, during the year 2021, from the beginning of the vaccination campaign for the elderly against COVID-19. Experience Description: Due to the scarcity of immunobiologicals, in the initial phase of vaccination against COVID-19, the Department of Health of the municipality of Massapê, state of Ceará, created an instrument to stratify the health, epidemiological and social risks of the elderly, containing sociodemographic data and comorbidities of the elderly. After establishing the variables, scores were established for the risk strata, which were classified as low (one to three points), medium (four to six points), high (seven to nine points) and very high (ten points and more). Final Considerations: The study shows that, despite the COVID-19 pandemic, an unprecedented global health crisis as already mentioned, specific actions, even if localized, can have a chain effect and be replicated in other scenarios and times.

Objetivo: Relatar la experiencia de construcción y uso de un instrumento de estratificación de riesgo para la vacunación de ancianos contra la COVID-19. Métodos: Informe de la experiencia desarrollada en el municipio de Massapê - Ceará, durante el año 2021, desde el inicio de la campaña de vacunación de ancianos contra la COVID-19. Descripción de la Experiencia: Debido a la escasez de inmunobiológicos, en la fase inicial de la vacunación contra la COVID-19, la Secretaría de Salud del municipio de Massapê, estado de Ceará, creó un instrumento para estratificar los riesgos sanitarios, epidemiológicos y sociales de los ancianos, que contiene datos sociodemográficos y comorbilidades de los ancianos. Luego de establecer las variables, se establecieron puntajes para los estratos de riesgo, los cuales se clasificaron en bajo (uno a tres puntos), medio (cuatro a seis puntos), alto (siete a nueve puntos) y muy alto (diez puntos y más). Consideraciones finales: El estudio muestra que, a pesar de la pandemia de COVID-19, una crisis sanitaria mundial sin precedentes como ya se mencionó, las acciones específicas, aunque sean localizadas, pueden tener un efecto en cadena y replicarse en otros escenarios y tiempos.

Situation and prevention strategies of sports injuries in community home sports under the background of covid-19 / A situação e estratégias de prevenção de lesões esportivas em esportes domésticos comunitários sob o pano de fundo da covid-19 / La situación y las estrategias de prevención y tratamiento de las lesiones deportivas en el hogar en la comunidad en el contexto del covid - 19

ABSTRACT Introduction: In the context of COVID-19, many physical activities have been restricted to the home environment, including traditional community sports. The situation of bodily injuries and prevention strategies during this period urges investigation and adaptation for a preventive approach. Objective: Explore the current scenario by devising means of prevention for sports injuries caused in the home environment. Methods: A total of 60 people were selected as experimental volunteers for home sports injury analysis, 30 in the experimental group and 30 in the control group, the cases were studied, and hypotheses were raised corroborating a preventive system of the cataloged home sports injuries, as well as the mitigation of their intercurrences. Results: In the experimental group, the flexion amplitude increased from 74.55±5.30 to 95.19±6.54; the extension amplitude increased from −3.88±3.29 to 1.57±2.17; the walking index evolved from 22.61±7.00 to 28.53±5.74; the stair activity index increased from 18.70±6.79 to 18.70±6.79. The same data measured in the control group showed no significant changes. Conclusion: Prevention of sports injuries during the current pandemic begins with the care of the immune system; care of the home environment was also described, as well as validation of effective treatment for timely rehabilitation of home sports injuries. Level of evidence II; Therapeutic studies - investigation of treatment outcomes.

RESUMO Introdução: No contexto da COVID-19, muitas atividades físicas restringiram-se ao ambiente doméstico, incluindo os esportes tradicionalmente comunitários. A situação das lesões corporais e as estratégias de prevenção durante este período urgem investigações e adaptações para uma abordagem preventiva. Objetivo: Explorar o cenário atual elaborando meios de prevenção para as lesões esportivas ocasionadas em ambiente domiciliar. Métodos: Um total de 60 pessoas foram selecionadas como voluntários experimentais para análise de lesão esportiva domiciliar, 30 no grupo experimental e 30 no grupo de controle, estudou-se os casos e foram levantadas hipóteses corroborando para um sistema preventivo das lesões esportivas domiciliares catalogadas, bem como a atenuação de suas intercorrências. Resultados: No grupo experimental, a amplitude de flexão aumentou de 74,55±5,30 para 95,19±6,54; a amplitude de extensão aumentou de −3,88±3,29 para 1,57±2,17; o índice de caminhada evoluiu de 22,61±7,00 para 28,53±5,74; o índice de atividade em escadas aumentou de 18,70±6,79 para 18,70±6,79. Os mesmos dados aferidos no grupo controle não apresentaram alterações significativas. Conclusão: A prevenção de lesões esportivas durante a pandemia atual inicia-se no cuidado do sistema imunológico, cuidados com o ambiente doméstico também foram descritos, bem como a validação de tratamento eficaz para a reabilitação das lesões esportivas domésticas em tempo hábil. Nível de evidência II; Estudos terapêuticos - investigação dos resultados do tratamento.

RESUMEN Introducción: En el contexto del COVID-19, muchas actividades físicas se han restringido al ámbito doméstico, incluidos los deportes comunitarios tradicionales. La situación de las lesiones corporales y las estrategias de prevención durante este período urgen investigaciones y adaptaciones para un abordaje preventivo. Objetivo: Explorar el escenario actual ideando medios de prevención para las lesiones deportivas causadas en el entorno doméstico. Métodos: Un total de 60 personas fueron seleccionadas como voluntarios experimentales para el análisis de las lesiones deportivas domiciliarias, 30 en el grupo experimental y 30 en el grupo control, se estudiaron los casos y se plantearon hipótesis corroborando para un sistema preventivo de las lesiones deportivas domiciliarias catalogadas, así como la mitigación de sus intercurrencias. Resultados: En el grupo experimental, la amplitud de flexión aumentó de 74,55±5,30 a 95,19±6,54; la amplitud de extensión aumentó de −3,88±3,29 a 1,57±2,17; el índice de marcha evolucionó de 22,61±7,00 a 28,53±5,74; el índice de actividad en escaleras aumentó de 18,70±6,79 a 18,70±6,79. Los mismos datos medidos en el grupo de control no mostraron cambios significativos. Conclusión: La prevención de las lesiones deportivas durante la pandemia actual comienza en el cuidado del sistema inmunológico, también se describió el cuidado del entorno del hogar, así como la validación de un tratamiento eficaz para la rehabilitación de las lesiones deportivas en el hogar de manera oportuna. Nivel de evidencia II; Estudios terapéuticos - investigación de los resultados del tratamiento.

Recommendations for the integral diagnosis of chronic viral hepatitis in a single analytical extraction. / Recomendaciones para el diagnóstico integral de las hepatitis virales crónicas en una única extracción analítica.

The Spanish Society of Digestive Pathology (SEPD), the Spanish Association for the Study of the Liver (AEEH), the Spanish Society of Infections and Clinical Microbiology (SEIMC) and its Viral Hepatitis Study Group (GEHEP), and with the endorsement of the Alliance for the Elimination of Viral Hepatitis in Spain (AEHVE), have agreed on a document to carry out a comprehensive diagnosis of viral hepatitis (B, C and D), from a single blood sample; that is, a comprehensive diagnosis, in the hospital and/or at the point of care of the patient. We propose an algorithm, so that the positive result in a viral hepatitis serology (B, C and D), as well as human immunodeficiency virus (HIV), would trigger the analysis of the rest of the virus, including the viral load when necessary, in the same blood draw. In addition, we make two additional recommendations. First, the need to rule out a previous hepatitis A virus (VHA) infection, to proceed with its vaccination in cases where IgG-type studies against this virus are negative and the vaccine is indicated. Second, the determination of the HIV serology. Finally, in case of a positive result for any of the viruses analyzed, there must be an automated alerts and initiate epidemiological monitoring.

Gestion de la crise covid à bord d'un navire de marine marchande : Atalante

Résumé Le navire Atalante de la marine marchande effectuait une mission scientifique en mars, avril 2020 alors que la pandémie de Covid se répandait sur la planète. Le personnel de bord a été confronté à un double risque, la rupture de soins médicaux courants et l'apparition d'un cluster à bord. Ces deux risques ont été évités en s'adaptant rapidement et efficacement à cette situation exceptionnelle. Une suppléance à la médicalisation habituelle a été mise en place et les mesures sanitaires ont été appliquées avec rigueur. Cette réponse est intéressante à considérer en cas de SSE (Situations sanitaires exceptionnelles) impliquant la médecine en situation d'isolement. Summary The merchant navy vesselAtalante was on a scientific mission in March, April 2020 as the Covid pandemic spread across the planet. The maritime crew were faced with a double risk, the interruption of routine medical care and the appearance of a cluster on board. These two risks were avoided by adapting quickly and effectively to this exceptional situation. A replacement for the usual medical treatment has been put in place and health measures have been rigorously applied. This answer is interesting to consider in the event of SSE (exceptional health situations) involving medicine in a situation of isolation.

Primary Care Physicians' Knowledge, Attitude and Practice towards Bariatric Operations in the Kingdom of Bahrain

Background: Obesity is an epidemic treatable disease. In Bahrain, the prevalence of obesity was 36.2%. Bariatric surgery should be considered for patients with BMI >= 40, or >= 30 with obesity-related comorbidities. Family physicians have a key role in identifying and counseling patients who may qualify for bariatric surgery. The most common reason for physicians' refusal of referral for bariatric surgeries is fear of complications followed by concern of ineffective weight loss following the surgery. Doctors are not comfortable providing post bariatric operation care. Aim(s): To study the PCPs' knowledge, attitude and practice towards bariatric surgeries in the kingdom of Bahrain. Method(s): this is a cross-sectional study of a convenient sample of physicians working in the Kingdom of Bahrain health centers, using an electronic and manual questionnaire to test the knowledge, attitude and practice towards bariatric surgery. Result(s): The sample included a total of 222 participants. 56.1% agreed that the BMI >= 40 without weight related comorbidities is an indication for bariatric surgery and 92.3% of them referred patients for bariatric surgery, with BMI (88.6%) as the most influential factor followed by presence of comorbidities (87.8%). On the other hand, lack of resources was the main cause for not referring patient for bariatric surgery (29.4%) followed by concerns with follow up (23.5%). 80.6% are comfortable to initiate conversations with their patients about bariatric surgery, while 36.1% feel comfortable explaining the procedural options to a patient. 83.8% agreed that additional medical education in bariatric surgical care would be useful. Conclusion(s): Primary care physicians showed well knowledge about the referral criteria to bariatric surgeries and that's reflected by the high referral rate (92.3%). But there is a gap in the knowledge mean score across different age groups and experience. Less than half of the physicians are not comfortable dealing with patients. Continuous medical education is essential to address the gap and to establish comprehensive obesity management guidelines for primary care physicians.Copyright © 2023, Bahrain Medical Bulletin. All rights reserved.

Are Biopsies Sufficient for Diagnosis Comparison of ESD and Forceps Biopsy Findings for Colon and Rectal Lesions

Introduction: Endoscopic submucosal dissection (ESD) is a minimally invasive technique used for removal of superficial dysplastic or early cancerous colon and rectal lesions. For larger lesions ( .20mm) that are not amenable to endoscopic mucosal resection, superficial biopsies are typically taken prior to referral for ESD. The aim of this study was to evaluate the degree of concordance between superficial forceps biopsies and ESD pathology. Method(s): A retrospective medical record review was performed including consecutive patients who underwent ESD of colon and rectal lesions at a tertiary care center between 10/2018 and 11/2021. Pathology results from outside hospital and same institution pre-ESD superficial forceps biopsies were compared to ESD pathology results. The primary outcome was the number of patients found to have higher disease severity on ESD pathology compared with superficial forceps biopsies. Result(s): Of the 84 patients who underwent ESD of colon or rectal lesions, 72 had pre-ESD superficial forceps biopsies which were taken at an outside hospital (n=48) or at the same institution (n=36). The average length of time between outside hospital superficial forceps biopsies and ESD was 91 days compared to 75 days for those performed at the same institution. Delays between superficial forceps biopsies and ESD may be related to the COVID-19 pandemic prolonging time between procedures. Pathology findings after ESD differed from superficial forceps biopsies in 31/72 patients (43%) with 21 patients receiving upgraded disease severity and 6 patients receiving a new cancer diagnosis based on ESD pathology. Patients who received a new cancer diagnosis had more days between superficial forceps biopsies and ESD compared with the whole cohort (86 vs 75, respectively). Conclusion(s): While superficial forceps biopsies of colon and rectal lesions were typically concordant with ESD pathology, 29% of patients in this cohort received upgraded disease severity based on ESD pathology. This shows that while superficial forceps biopsies can aid in diagnosis, en bloc resection via ESD remains critical for accurate diagnosis of large colon and rectal lesions. These results also show that ESD is not only diagnostic but therapeutic given 75% of the patients in this cohort achieved R0 resection.

Educational trajectories, health and longevity

The working group of the Academies of Medicine of France and Mexico initiated its work after the first wave of the COVID 19 pandemic, during which the severity of the disease in certain countries was attributed to a lack of basic education of the population. The study continued and expanded to better understand the roles of basic education and health education on overall health and longevity. This work has demonstrated that, alongside genetics, the affective and educational family environment but also the general one greatly interferes from the very first days of life. Thus, epigenetics plays a major role in the determination of health and disease (DOHAD) as well as in the characterization of gender. Other factors such as socio-economic level, parental education, school in urban or rural areas play a major role in the differential acquisition of health literacy. This determines adherence or not to healthy lifestyles, risky behaviors, substance abuse, but also compliance with hygiene rules and adherence to vaccines and treatments. The combination of all these elements and lifestyle choices facilitates the emergence of metabolic disorders (obesity, diabetes) which promote cardiovascular and kidney damages and neurodegenerative diseases, explaining that the less educated have a shorter survival while they spend more years of life in disability. After having demonstrated the impact of the educational level on health and longevity, the members of the inter-academic group propose specific educational actions at three levels: 1) Children, their parents, and teachers, 2) health professionals and 3) aging people, after emphasizing that these crucial actions can only be carried out with the unfailing support of state and academic authorities. © 2023 l'Académie nationale de médecine Le groupe de travail des Académies de Médecine de France et du Mexique a initié son travail après que la sévérité de la première vague de la pandémie Covid 19 de certains pays ait été corrélée à un manque d'éducation de base de leur population. La réflexion s'est poursuivie et étendue pour mieux comprendre les rôles de l'éducation de base et de l'éducation en santé sur la santé globale et la longévité. Ce travail montre qu'à côté de la génétique, l'épigénétique interfère de façon majeure dès les tous premiers jours de la vie dans la détermination de la santé et des maladies (DOHAD) ainsi que dans la caractérisation du genre. D'autres facteurs environnementaux et/ou éducatifs, comme le niveau socioéconomique ou les modalités de scolarisation (urbain ou rural) interviennent également dans l'acquisition différentielle d'une littératie en santé. Celle-ci détermine l'adhésion ou non à des styles de vie saine, à des comportements à risque, à l'abus de substances, mais aussi au respect des règles d'hygiène et à l'adhésion aux vaccins. Tous ces éléments et choix de vie se conjuguent entre eux pour faciliter la survenue ou la gravité de pathologies. Ainsi, les troubles métaboliques (obésité, diabète) surviennent plus souvent chez les moins éduqués, favorisant les atteintes cardiovasculaires, rénales et les maladies neurodégénératives. Globalement, les personnes moins éduquées vivent moins longtemps après avoir passé plus d'années de vie en incapacité fonctionnelle et dépendance. Après avoir démontré l'impact du niveau éducatif sur la santé et la longévité, les membres du groupe interacadémique déclarent l'urgence des actions à entreprendre et proposent des actions éducatives spécifiques à trois niveaux : 1) les enfants, leurs parents et les enseignants, 2) les professionnels de santé et 3) les personnes vieillissantes, tout en soulignant que ces actions cruciales ne pourront être menées qu'avec le soutien indispensable des autorités étatiques et académiques. © 2023 l'Académie nationale de médecine

Cycle threshold predicted mortality in a cohort of patients with hematologic malignancies infected with SARS-CoV-2.

When a SARS-CoV-2 RT-qPCR test is performed, it may determine an indirect measure of viral load called cycle threshold (Ct). Respiratory samples with Ct <25.0 cycles are considered to contain a high viral load. We aimed to determine whether SARS-CoV-2 Ct at diagnosis could predict mortality in patients with hematologic malignancies (lymphomas, leukemias, multiple myeloma) who contracted COVID-19. We included 35 adults with COVID-19 confirmed by RT-qPCR performed at diagnosis. We evaluated mortality due to COVID-19 rather than mortality due to the hematologic neoplasm or all-cause mortality. Twenty-seven (27) patients survived and 8 died. The global mean Ct was 22.8 cycles with a median of 21.7. Among the survivors, the mean Ct was 24.2, and the median Ct value was 22.9 cycles. In the deceased patients, the mean Ct was 18.0 and the median Ct value was 17.0 cycles. Using the Wilcoxon Rank Sum test, we found a significant difference (p=0.035). SARS-CoV-2 Ct measured in nasal swabs obtained at diagnosis from patients with hematologic malignancies may be used to predict mortality.

Impact of the first wave of the COVID-19 pandemic on French Health students.

CONTEXT: In France, care workers and health students have been intensely mobilized during the first wave of the COVID-19 pandemic. But few studies have evaluated psychological distress on non-medical health students, in addition to the challenges posed by pedagogical continuity while universities are closed following health and safety regulations. OBJECTIVES: This study aims to assess COVID-19's impact on health students in France on different levels: psychological, educational and social. METHODS: An online national cross-sectional study, from April 11 to May 30 2020, included sociodemographic, work conditions and numeric scales. RESULTS: A total of 4411 students answered. Regarding the K6 scale, 39% of students had moderate distress, and 21% had a high level of distress. Risk factors of psychological distress included being a woman (P<0.001), being between 19 and 21 years old (P<0.001), living alone (P=0.008), and not having the ability to isolate (P<0.001). Students on the frontline had less psychological distress (57 vs 62%, P=0.003), better quality of sleep (34% vs 28% high quality, P<0.001) but a higher consumption of medical (8.5% vs 6.5%, P=0.044) and non-medical (18% vs 10%, P<0.001) psychotropic drugs. Nurse and medical students had more distress and used more non-medical psychotropic substances than other health students (15% vs 9.2%). DISCUSSION: COVID-19' crisis had an important impact on health students' mental health, social life and training with discrepancies regarding the speciality whether they were on the frontline or not. There is an urgent need for psychological and pedagogical support for students, and even more so regarding the prolongation of the COVID-19 epidemic.

Adherence to online psychotherapy during the COVID-19: a scoping review / Adesão à psicoterapia on-line durante a COVID-19: uma revisão de escopo / Adherencia a la psicoterapia online durante el COVID-19: una revisión del alcance

Evidence suggests that changes in online psychotherapy adherence factors occurred during the COVID-19 pandemic. Thus, this study aimed to review the perception of patients and psychotherapists regarding factors associated with adherence to online psychotherapy during the pandemic. Thus, 18 articles remained for analysis after searches in five databases and 25 factors associated with adherence to online psychotherapy were identified. The main factors for psychotherapists were confidence in professional skills and connection stability. For the patients, basic informatics skills and finding an adequate setting to participate in sessions. Furthermore, the factors fear of contagion, tiredness and the impossibility of face-to-face meetings emerged during the pandemic. Modifications of factors associated with pre-pandemic adherence were identified and strategies to overcome barriers related to online sessions were presented and discussed. The pandemic has increased adherence to online psychotherapy, although not everyone intends to follow this modality in the post-pandemic. (AU)

Evidências sugerem que ocorreram modificações nos fatores de adesão a psicoterapia online durante a pandemia de COVID-19. Assim, este estudo objetivou revisar a percepção dos pacientes e psicoterapeutas sobre fatores associados a adesão à psicoterapia online durante a pandemia. Restaram 18 artigos para análise após as buscas em cinco bases de dados. Foram identificados 25 fatores associados a adesão a psicoterapia on-line. Para os psicoterapeutas, os principais fatores foram a confiança nas habilidades profissionais e estabilidade da conexão. Para os pacientes, foram o conhecimento básico de informática e encontrar setting adequado para participar das sessões. Ademais, os fatores medo do contágio, cansaço e a impossibilidade de reuniões presenciais surgiram durante a pandemia. Modificações em fatores associados a adesão pré-pandemia foram identificadas e estratégias para contornar barreiras relacionadas aos atendimentos on-line foram apresentadas e discutidas. A pandemia aumentou a adesão a psicoterapia on-line, mas nem todos pretendem seguir nessa modalidade no pós-pandemia. (AU)

Evidencias sugieren que se produjeron cambios en los factores de adherencia a la psicoterapia en línea durante la pandemia del COVID-19. Por lo tanto, este estudio busca revisar las percepciones de pacientes y psicoterapeutas sobre los factores asociados a la adherencia a la psicoterapia en línea durante la pandemia. Se analizaron 18 artículos seleccionados tras una búsqueda en cinco bases de datos. Se identificaron 25 factores de la adherencia a la psicoterapia en línea. Para los psicoterapeutas, los principales factores fueron la confianza en las competencias profesionales y la estabilidad de la conexión. Ya para los pacientes, los factores básicos fueron las habilidades informáticas básicas y la búsqueda del entorno adecuado para participar en las sesiones. Además, durante la pandemia surgieron los factores miedo al contagio, cansancio y la imposibilidad de encuentros físicos. Se identificaron modificaciones en los factores asociados a adherencia prepandémica y se presentaron y discutieron estrategias para superar las barreras relacionadas con las sesiones en línea. La pandemia aumentó la adhesión a la psicoterapia en línea, aunque no todos tengan la intención de seguir esta modalidad en la pospandemia. (AU)

University teaching in gynecology and obstetrics in Peru / Docencia universitaria en ginecología y obstetricia en el Perú

RESUMEN La docencia en obstetricia y cirugía en el Perú empezó a principios del siglo XIX, por iniciativa de Hipólito Unanue. Cayetano Heredia y otros la estructuraron académicamente al crearse la Facultad de Medicina de la Universidad Nacional Mayorde San Marcos, en 1856. La cátedra de clínica ginecológica fue creada finalizando el siglo XIX, nombrándose como catedrático a Constantino T. Carvallo. En 1947 se fundó la Sociedad Peruana de Obstetricia y Ginecología (SPOG), con la finalidad de desarrollar la ciencia y la capacitación continua de especialistas en ginecología y obstetricia. Desde 1955, la Revista Peruana de Ginecología y Obstetricia es el medio de comunicación científica de la SPOG, que publica experiencias e investigaciones en la especialidad. El residentado en Obstetricia data de 1958 en la Maternidad de Lima y, entre 1961 y 1962, Abraham Ludmir comenzó el residentado escolarizado de obstetricia y ginecología en el Hospital Materno Infantil San Bartolomé. El continuo y rápido avance dado por la investigación científica, información y modernización de la tecnología en la especialidad ha ocasionado la aparición de varios capítulos relacionados a la patología de la mujer y el perinato, integradas en instituciones médicas que avanzan a diferente velocidad e importancia. La actual pandemia del coronavirus SARS-CoV-2 ha puesto en evidencia los problemas en la atención de salud nacional, ocasionando congestión hospitalaria, insuficiencia de equipos, medicamentos y recursos humanos, indicadores desfavorables de vigilancia, infecciones y muertes, lo que requerirá girar la gestión en salud. La docencia en medicina también se vio afectada, con conversión de la educación presencial a virtual, prohibición de atención presencial de estudiantes y docentes mayores, que recién retornarán a los hospitales. La educación médica, los avances científicos y tecnológicos y la visión de un mundo rápidamente cambiante deben originar nuevos planes curriculares para los estudiantes de medicina y residentes en la especialidad, para una apropiada atención en salud.

ABSTRACT The teaching of obstetrics and surgery in Peru began at the beginning of the 19th century, at the initiative of Hipólito Unanue. Cayetano Heredia and others structured it academically when the Faculty of Medicine of the Universidad Nacional Mayor de San Marcos was created in 1856. The chair of clinical gynecology was created at the end of the 19th century, appointing Constantino T. Carvallo as professor. In 1947, the Peruvian Society of Obstetrics and Gynecology (SPOG) was founded with the purpose of developing the science and continuous training of specialists in gynecology and obstetrics. Since 1955, The Peruvian Journal of Gynecology and Obstetrics is the scientific communication media of the SPOG, which publishes experiences and research in the specialty. The residency in Obstetrics dates back to 1958 at the Maternity Hospital of Lima and, between 1961 and 1962, Abraham Ludmir began the schooled residency in obstetrics and gynecology at the Hospital Materno Infantil San Bartolomé. The continuous and rapid progress given by scientific research, information and modernization of technology in the specialty has caused the emergence of several branches related to the pathology of women and perinates, integrated in medical institutions that advance at different speed and importance. The current SARS-CoV-2 coronavirus pandemic has highlighted the problems in national health care, resulting in hospital congestion, insufficient equipment, drugs and human resources, unfavorable indicators of surveillance, infections and deaths, which will require a change in health management. Teaching in medicine was also affected, with the conversion from classroom to virtual education, prohibition of on site care for students and senior teachers, who will be returning to the hospitals. Medical education, scientific and technological advances and the vision of a rapidly changing world must give rise to new curricular plans for medical students and residents in the specialty, for appropriate health care.

Impact of COVID-19 pandemic on cardiology fellows academic training: beyond the clinical impact.

OBJETIVO: Determinar la percepción de los médicos internos residentes (MIR) de cardiología de España sobre el efecto de la pandemia por COVID-19 en su formación y la adaptación realizada por sus servicios. MÉTODOS: Estudio de corte transversal a través de una plataforma de encuesta digital con el objetivo de conocer la opinión individual de los MIR de cardiología sobre la influencia de la pandemia en su formación. Se realiza un análisis estadístico para determinar los factores que influyeron en la percepción de la formación afectada. RESULTADOS: Participó un total de 180 MIR de las 17 comunidades autónomas (CA). Los MIR de tercer año fueron los más afectados, junto con los que rotaban en imagen cardíaca. Los residentes de las CA con una prevalencia >5 casos/1,000 habitantes fueron los que mayor probabilidad tuvieron de ser desplazados de sus servicios. CONCLUSIONES: Según la opinión de los participantes, el efecto de la pandemia por COVID-19 en su formación fue más negativa en los residentes de tercer año y los que rotaban en imagen cardíaca. OBJECTIVE: The objectives were to analyze the perception of the Cardiology Fellows in Training (FIT) of Spain about the impact of the COVID-19 pandemic on their academic training and to know the adaptative changes performed by their department. METHODS: A cross-sectional study performed through a digital survey platform for Cardiology FIT. Chi2 analysis and logistic regression were performed to determine the factors that influenced on the perception of an affected training. RESULTS: A total of 180 FIT from the 17 regions of Spain participated. Third year FIT and those rotating in cardiac imaging were the most affected with statistically significant difference. The residents of the regions with a prevalence of >5 cases/1,000 inhabitants were the most likely to be displaced from their departments. CONCLUSIONS: According to the opinion of the participants, the impact of the COVID-19 pandemic on their academic training was more negative in third year FITs and those rotating in cardiac imaging.

Evaluation of the impact of online education on the health-related quality of life of medical students in Lebanon

Introduction One of the adopted measures during the Coronavirus disease of 2019 (COVID-19) pandemic in education is the online modality, which can impact students' quality of Life (QoL) and their academic performance. Methods This cross-sectional study aims to assess the impact of online education on health-related QoL in a sample of 401 medical students. Results Most students attended all the online sessions, and around 32% participated in some of them. Only 16.2% reported high satisfaction from the online sessions, and almost 39% reported low satisfaction. Overall, medical students had moderate QoL. Online education affected medical students psychologically more than physically, translated by higher scores for the physical components than the mental ones. Students who preferred online over in-person education had significantly lower scores for the mental domains, namely lower social functioning and emotional role scores. Academic satisfaction did not influence any SF-36 scores, and students' preferences (online or in-person education) did not affect any of the physical component scores. Conclusion The pandemic directly impacted the QoL of medical students, namely their mental health. Medical students in Lebanon had a higher preference for in-person education, possibly due to its novelty and to other technological, technical, or personal challenges. Future research exploring the reasons and viable solutions should be performed to maintain a steady level of education during unanticipated situations. Resumen Introducción Una de las medidas adoptadas durante la pandemia de la enfermedad por Coronavirus de 2019 (COVID-19) en la educación es la modalidad en línea, la cual puede impactar la calidad de Vida (CdV) de los estudiantes y su rendimiento académico. Métodos Este estudio transversal tiene como objetivo evaluar el impacto de la educación en línea en la calidad de vida relacionada con la salud en una muestra de 401 estudiantes de medicina. Resultados La mayoría de los estudiantes asistieron a todas las sesiones en línea y alrededor del 32% participó en algunas de ellas. Solo el 16,2 % reportó una alta satisfacción con las sesiones en línea y casi el 39 % reportó una baja satisfacción. En general, los estudiantes de medicina tenían una CdV moderada. La educación en línea afectó a los estudiantes de medicina psicológicamente más que físicamente, lo que se traduce en puntajes más altos para los componentes físicos que para los mentales. Los estudiantes que preferían la educación en línea a la presencial tenían puntajes significativamente más bajos en los dominios mentales, es decir, puntajes más bajos en el funcionamiento social y el rol emocional. La satisfacción académica no influyó en ningún puntaje del SF-36, y las preferencias de los estudiantes (educación en línea o en persona) no afectaron ninguno de los puntajes del componente físico. Conclusión la pandemia impactó directamente en la CdV de los estudiantes de medicina, es decir, en su salud mental. Los estudiantes de medicina en el Líbano tenían una mayor preferencia por la educación presencial, posiblemente debido a su novedad y a otros desafíos tecnológicos, técnicos o personales. Se deben realizar investigaciones futuras que exploren las razones y las soluciones viables para mantener un nivel constante de educación durante situaciones imprevistas.

Un concours d'écriture sur le Covid pour les étudiants du collège des sciences de la santé de Bordeaux

Résumé Dans le cadre du projet « Récits face au Covid » porté par l'institut de médecine intégrative et complémentaire (IMIC) du CHU de Bordeaux, soutenu par le groupe Impulsion « Domofrance et Crédit Mutuel du Sud-Ouest » et accompagné par la fondation Bordeaux université, un concours d'écriture a été proposé aux étudiants en sciences de la santé du Collège des Sciences de la santé de Bordeaux, afin d'explorer par le récit comment la pandémie avait modifié leur regard sur le soin. Summary As part of the "Stories facing the Covid” project led by the Institute of Integrative and Complementary Medicine (IMIC) of the Bordeaux University Hospital, supported by the Impulsion group "Domofrance and Crédit Mutuel du Sud-Ouest” and accompanied by the Bordeaux Foundation University, a writing competition was offered to health science students at the Bordeaux College of Health Sciences, in order to explore through storytelling how the pandemic had changed their view of care.

¿Prono en ventilación espontánea? Un problema de inducción: una revisión panorámica

Resumen Introducción El prono en ventilación espontánea no es una estrategia reciente, y pese a los muchos años que lleva intentando consolidarse, no ha podido demostrar ser de real utilidad. Durante la reciente pandemia, el prono en ventilación espontánea resurgió como una alternativa práctica y simple, aunque muy cuestionada por su débil nivel de evidencia. Con el tiempo y la experiencia generada, de a poco fue relegada a convertirse únicamente en una atractiva hipótesis. Objetivo Este estudio busca analizar los potenciales beneficios del prono en ventilación espontánea en pacientes con hipoxemia producida por SARS-CoV-2. Método Se realizó una revisión panorámica de los estudios más relevantes publicados en las bases de datos MEDLINE, Embase y Scopus hasta el 20 de diciembre de 2021. Resultados Tras el escrutinio se eligieron para el análisis: 4 estudios observacionales, un ensayo clínico aleatorizado y 3 revisiones sistemáticas. Conclusiones Mediante análisis estadísticos concluimos que el prono en ventilación espontánea, si bien podría retrasar la intubación, no mejoraba la sobrevida de los sujetos hipoxémicos por neumonía viral causada por coronavirus tipo 2. Intoduction Prone position in spontaneous ventilation is not a recent strategy, and despite the many years it has been trying to consolidate, it has not been able to prove to be of real utility. During the recent pandemic, prone spontaneous ventilation re-emerged as a practical and simple alternative, although it was highly questioned due to its weak level of evidence. With time and experience, it was gradually relegated to become only an attractive hypothesis. Objective This study aims to analyze the potential benefits of prone position in spontaneous ventilation in patients with hypoxemia caused by SARS-CoV-2. Methods A panoramic review of the most relevant studies published in the MEDLINE, Embase and Scopus databases up to December 20, 2021 was performed. Results After screening, 4 observational studies, 1 randomized clinical trial, and 3 systematic reviews were selected for analysis. Conclusions By statistical analysis we concluded that prone position in spontaneous ventilation, although it could delay intubation, did not improve survival in hypoxemic subjects with viral pneumonia caused by coronavirus type 2.

Une étude multicentrique, ouverte, à un bras, de phase IIIb (CONSONANCE) visant à évaluer l'efficacité et la tolérance d'ocrélizumab chez des patients atteints de SEP-PP et SEP-SP : résultats de l'analyse intermédiaire à 2 ans

Introduction Ocrélizumab (OCR) a démontré son efficacité sur l'évolution de la sclérose en plaques primaire-progressive (SEP-PP). Cependant, des données sont manquantes sur l'ensemble des formes progressives, dont la SEP-secondairement progressive (-SP). Objectifs CONSONANCE (NCT03523858) est une étude de phase 3b à un bras, d'une durée de 4 ans, évaluant pour la première fois l'efficacité et la tolérance d'OCR dans la SEP-PP et la SEP-SP. Les résultats à 2 ans sont rapportés. Méthodes Des patients atteints de SEP progressive active ou non active avec une progression du handicap dans les 2 ans étaient inclus. Les critères d'évaluation étaient : (1) proportion de patients sans signe de progression (NEP, pas d'augmentation de l'EDSS sur ≥ 24 semaines, ≥ 20 % du temps aux tests T25FWT et 9HPT, pas de décès lié à la SEP ou d'arrêt de traitement pour manque d'efficacité) ;(2) proportion de patients sans signe de progression ni activité de la maladie (NEPAD, NEP+pas de poussées ni lésions T1 au gadolinium et T2 nouvelles/élargies). Résultats Les patients (n=629, SEP-SP n=324, SEP-PP n=305) avaient un âge moyen (DS) de 48,5 (9,2) ans et 52 % étaient des femmes. À l'inclusion, les scores EDSS médians (IQR)/moyens (DS) étaient de 6,0 (4,5–6,0)/5,3 (1,3) pour les patients SEP-SP et 5,0 (4,0–6,0)/4,8 (1,3) pour les patients SEP-PP. Les temps médians des tests 9HPT et T25FWT étaient de 27,9 et 9,4sec. Sur 2 ans, 311/586 (53,1 %) patients ont atteint le NEP (SEP-SP : 55,8 % ;SEP-PP : 50,2 %) et 283/588 (48,1 %) le NEPAD (SEP-SP : 49,5 % ;SEP-PP : 46,7 %). Discussion L'EDSS est resté stable de l'inclusion à 2 ans (évolution moyenne [DS] de +0,07 [0,79] points). Au total, 29,8 % des patient avec un EDSS à l'inclusion ≥ 2,0 (n=528) ont eu une amélioration confirmée du handicap à 24 semaines (EDSS, T25FWT, 9HPT). Les taux d'événements indésirables graves et d'infections étaient de 7,6/100 patients-années (PA) et de 3,2/100 PA. Huit décès ont été rapportés (COVID-19=6, embolie pulmonaire=1, cancer du poumon=1). Conclusion Sur 2 ans, le traitement par OCR a été associé à des taux comparables de NEP et NEPAD chez les patients SEP-SP et SEP-PP avec des améliorations fonctionnelles pour 1/3 des patients. Le profil de tolérance était conforme à celui connu pour OCR.

Actualités épidémiologiques des troubles neuropsychiatriques dans un pays en crise structurelle : le cas du Liban

Introduction Avant 2022, le Liban était classé comme pays à revenu intermédiaire supérieur, l'âge de la population était croissant, et les maladies chroniques (dont les troubles neuropsychiatriques tel que l'AVC, l'épilepsie, la schizophrénie, la dépression et l'anxiété) y sont aussi prévalentes que dans les pays avancés (sinon plus). Dès 2020, le Liban connaissait une crise économique et sociale, aggravée par la pandémie COVID-19 et l'explosion accidentelle dans le port de Beyrouth, entraînant une déliquescence du système de santé, jusqu'alors considéré comme l'un des meilleurs du Moyen Orient. Actuellement, le secteur médicamenteux souffre de pénuries sévères, ce qui risque d'entraîner des complications significatives. L'objectif de cette présentation et de montrer l'état des lieux des maladies neuropsychiatriques au Liban, dans le contexte de crise actuelle sans précédent. Méthodes Une revue de la littérature a été menée, visant à évaluer les études épidémiologiques sur les maladies neuropsychiatriques au Liban de 2012–2022. Résultats La majorité des études publiées durant la période de la crise Libanaise, étaient des études transversales menées en ligne ou des études cliniques ;si la prévalence des maladies neuropsychiatriques était difficile à évaluer en raison des méthodes utilisées, les corrélats et facteurs de risque ont été identifiés. Le niveau socioéconomique contemporain affecte non seulement l'incidence de la maladie, mais également la qualité de la prise en charge. De fait, la crise économique a augmenté le stress, et a affecté l'état des patients au Liban, avec une nette augmentation du risque de complication lié au manque d'adhérence au traitement (les patients ayant des difficultés à accéder aux médicaments : pénurie, prix exorbitants, falsification) et la disparition de la couverture assurance médicale. Conclusion Le fardeau des maladies neuropsychiatriques au Liban s'est accentué dans le contexte contemporain du pays ;la prévention primaire y est de première importance, vu que la prise en charge de ces maladies devient de plus en plus difficile et coûteuse.