Together towards tomorrow: partnerships powering the digital transformation of the health sector

This editorial presents a collective vision of unity, innovation and collaboration, and a shared desire for resilient and more equitable health systems worldwide, urging the global health community to harness the collective strength of alliances and international collaboration to guide the health sector into a new era of digital transformation and innovation.

From national and regional commitments to global impact: artificial intelligence for equitable public health at the G20

Artificial intelligence (AI) is rapidly transforming numerous sectors and public health is no exception. As a powerful tool for modernizing health systems and services, AI promises to improve health outcomes, enhance efficiency and ensure innovation in public health practices. The G20, representing the world’s largest economies, plays a crucial role in shaping global health policies and driving forward initiatives that leverage AI for public health (1). Through its influential platform, this political body has the capacity to foster international collaboration, share knowledge, and recommend and support global standards that prioritize AI integration into public health. Health equity remains a fundamental principle of global public health goals, emphasizing the need for universal access to quality health care services regardless of geographical, economic or social barriers. AI holds immense potential to bridge health disparities, particularly for underserved populations. The G20’s commitment to embrace AI in public health underscores a collective effort to address these disparities, ensuring that technological advancements do not leave anyone behind.

Investigating under-reported human papillomavirus genotypes in Grenadian women through self-sampling for cervical cancer screening / Investigación de los genotipos de virus del papiloma humano infranotificados en mujeres de Granada mediante automuestreo para el tamizaje del cáncer cervicouterino / Investigação de genótipos subnotificados de papilomavírus humano em mulheres de Granada por meio de autoamostragem para rastreamento de câncer do colo do útero

[ABSTRACT]. Objective. To compare the adequacy, agreement, and acceptability of Papanicolaou testing (cytology) for cervical cancer screening using self-collected samples compared to physician-collected samples in Grenada in the Caribbean. Furthermore, the study identifies the human papillomavirus (HPV) genotypes present among asymptomatic women testing positive for HPV, the etiologic cause of cervical cancer. Methods. Participants were divided into two groups and two cervical samples were collected from the women in each group: a self-collected sample and a physician-collected sample. Cervical specimens were tested for cytology and HPV. HPV genotyping was performed on positive specimens. Results. Self-collected samples were adequate and in agreement with physician-collected samples, showing no difference between the two sampling methods. Oncogenic high-risk HPV genotypes were identified in cervical samples which were positive for atypical squamous cells and low-grade squamous intraepithelial lesions. The high-risk HPV genotypes found, notably HPV 45 and 53, differed from those most commonly reported. Although the commonly reported high-risk genotypes HPV 16 and 18 were found, so were 31, 33, 35, 52, 66, 68, and 82. Conclusions. Using self-collection facilitated the discovery of unexpected HPV genotypes among asymptomatic women in Grenada. These findings add new information to the literature regarding cervical cancer and neoplasia screening and HPV genotypes in the Caribbean. This genotype information may impact surveillance of women with low-grade lesions, HPV vaccine selection, and possibly further vaccine research. Research regarding HPV in Caribbean pathology samples of cervical neoplasia and cancer is needed.

[RESUMEN]. Objetivo. Comparar la idoneidad, concordancia y aceptabilidad de la prueba de Papanicolaou (citología) para el tamizaje del cáncer cervicouterino mediante la comparación de muestras obtenidas con automuestreo y muestras tomadas por personal médico en Granada, en el Caribe. Asimismo, en el estudio se identifican los genotipos del virus del papiloma humano (VPH) existentes en las mujeres asintomáticas con un resultado positivo en las pruebas del VPH, la causa etiológica del cáncer cervicouterino. Métodos. Las participantes se dividieron en dos grupos y se tomaron dos muestras cervicouterinas de las mujeres de cada grupo: una muestra tomada por la propia paciente y una muestra tomada por personal médico. Se realizó un examen citológico y una prueba de detección del VPH en las muestras. En las muestras positivas, se determinó el genotipo del VPH. Resultados. Las muestras tomadas por las propias pacientes fueron adecuadas y concordaron con las obtenidas por el personal médico, sin que se observaran diferencias entre ambos métodos de muestreo. Se identificaron genotipos de VPH de alto riesgo oncogénico en muestras cervicouterinas positivas para células escamosas atípicas y lesiones intraepiteliales escamosas de grado bajo. Los genotipos de VPH de alto riesgo encontrados, en especial VPH 45 y 53, diferían de los notificados con mayor frecuencia. Aunque se encontraron los genotipos de alto riesgo habituales 16 y 18 del VPH, también se encontraron los genotipos 31, 33, 35, 52, 66, 68 y 82. Conclusiones. El uso del automuestreo facilitó la detección de genotipos inesperados del VPH en mujeres asintomáticas de Granada. Estos resultados agregan nueva información a la bibliografía sobre el tamizaje de las neoplasias y el cáncer cervicouterino, así como sobre los genotipos del VPH, en el Caribe. Esta información sobre el genotipo puede repercutir en la vigilancia de las mujeres con lesiones de bajo grado, en la elección de la vacuna contra el VPH y, posiblemente, en las ulteriores investigaciones sobre vacunas. Es necesario investigar la presencia del VPH en muestras anatomopatológicas de neoplasias y cánceres cervicouterinos en el Caribe.

[RESUMO]. Objetivo. Comparar a adequação, o nível de concordância e a aceitabilidade do exame de Papanicolau (citologia) para o rastreamento do câncer do colo do útero usando amostras autocoletadas em comparação com amostras coletadas por médicos em Granada, no Caribe. Além disso, o estudo identifica os genótipos de papilomavírus humano (HPV) presentes entre as mulheres assintomáticas com resultado positivo para HPV, a causa etiológica do câncer do colo do útero. Métodos. As participantes foram divididas em dois grupos, e duas amostras cervicais foram coletadas das mulheres de cada grupo: uma amostra autocoletada e uma amostra coletada por um médico. As amostras cervicais foram submetidas a exames citológicos e de HPV. A genotipagem do HPV foi realizada nas amostras positivas. Resultados. As amostras autocoletadas eram adequadas e compatíveis com as amostras coletadas por médicos, não havendo diferença entre os dois métodos de amostragem. Foram identificados genótipos de HPV de alto risco oncogênico em amostras cervicais positivas para células escamosas atípicas e lesões intraepiteliais escamosas de baixo grau. Os genótipos de HPV de alto risco encontrados, principalmente HPV 45 e 53, não correspondiam aos genótipos registrados com mais frequência na literatura. Embora os genótipos de alto risco HPV 16 e 18, que são frequentemente registrados, tenham sido observados, também foram detectados os genótipos 31, 33, 35, 52, 66, 68 e 82. Conclusões. O uso da autocoleta facilitou a detecção de genótipos inesperados de HPV entre mulheres assintomáticas em Granada. Esses achados adicionaram novas informações à literatura sobre o rastreamento de neoplasias e câncer do colo do útero e sobre os genótipos de HPV no Caribe. Essas informações genotípicas podem afetar a vigilância de mulheres com lesões de baixo grau, a seleção da vacina contra o HPV e, possivelmente, futuras pesquisas sobre vacinas. É necessário pesquisar o HPV em amostras patológicas de neoplasias cervicais e câncer do colo do útero no Caribe.

Introducing the concept of digitally smart health facilities: a vision for the future

The adoption of the digitally smart health facilities (DSHFs) concept introduces a new paradigm in today’s public health environment, potentially opening possibilities for addressing many challenges. This editorial explores the concept, emphasizing its potential to revolutionize the health care landscape by integrating digital infrastructure, tools, services and digital literacy within the planning and construction or renovation of health facilities at all levels of care. This innovative concept could pave the way for transformative changes in health care delivery, and improve patients’ outcomes and operational efficiencies, bringing health care closer to patients not only during day-to-day operations but also during health emergencies and disasters. This editorial highlights the significant contributions made by digital health solutions to the safe hospitals initiative led by the Pan American Health Organization (PAHO), emphasizing the role of information and communication technologies in enhancing access to care.

Genetic variants associated with poor responsiveness to sulfonylureas in Filipinos with type 2 diabetes mellitus / Journal of the ASEAN Federation of Endocrine Societies

Introduction@# Sulfonylureas (SUs) are commonly used drugs for type 2 diabetes mellitus (T2DM) in the Philippines. This study aimed to associate genetic variants with poor response to gliclazide and glimepiride among Filipinos.@*Methodology@#Two independent, dichotomous longitudinal substudies enrolled 139 and 113 participants in the gliclazide and glimepiride substudies, respectively. DNA from blood samples underwent customized genotyping for candidate genes using microarray. Allelic and genotypic features and clinical associations were determined using exact statistical methods.@*Results@#Three months after sulfonylurea monotherapy, 18 (13%) were found to be poorly responsive to gliclazide, while 7 (6%) had poor response to glimepiride. Seven genetic variants were nominally associated (p<0.05) with poor gliclazide response, while three variants were nominally associated with poor glimepiride response. For gliclazide response, carboxypeptidase-associated variants (rs319952 and rs393994 of AGBL4 and rs2229437 of PRCP) had the highest genotypic association; other variants include rs9806699, rs7119, rs6465084 and rs1234315. For glimepiride response, 2 variants were nominally associated: CLCN6-NPPA-MTHFR gene cluster – rs5063 and rs17367504 – and rs2299267 from the PON2 loci.@*Conclusion@#Genetic variants were found to have a nominal association with sulfonylurea response among Filipinos. These findings can guide for future study directions on pharmacotherapeutic applications for sulfonylurea treatment in this population.

Philippine pediatric COVID-19 living clinical practice guidelines as of March 2022

Executive Summary@#The Coronavirus disease 2019 (COVID-19) pandemic has triggered a global crisis and has affected millions of people worldwide. With the evolution of the different variants of concern, the incidence of COVID- 19 in the pediatric population has risen. The Surveillance and Analysis of COVID-19 in Children Nationwide (SALVACION) Registry, developed by the Pediatric Infectious Disease Society of the Philippines (PIDSP) and the Philippine Pediatric Society (PPS), has reported 3,221 cases as of March 31, 2022, with 90.4% requiring hospitalization and 36.2% with moderate to critical disease severity. Given the magnitude of the impact of COVID-19, with most of the clinical recommendations available designed towards adult patients, there was an urgent need for clinicians, public health officials and the government to also prioritize evidence-based clinical practice guidelines for the pediatric population. Hence, the development of the Philippine Pediatric COVID-19 Living Clinical Practice Guidelines was conceptualized. This independent project, funded and supported by the PPS and PIDSP, aimed to formulate up-to-date, evidence-based recommendations on the treatment, diagnosis, infection prevention and control of COVID-19 in children. Following the standard CPG development process outlined in the DOH Manual for CPG Development and the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology, 15 evidence summaries and 24 recommendations were generated by 12 consensus panelists representing their specific health organizations and institutions.

2021 clinical practice guidelines in the evaluation and management of pediatric community-acquired pneumonia

Preface@#The Clinical Practice Guidelines (CPG) for the Diagnosis and Management of Pediatric Community-Acquired Pneumonia (PCAP) was initiated by the Philippine Academy of Pediatric Pulmonologists, Inc. (PAPP) and the Pediatric Infectious Disease Society of the Philippines (PIDSP), in cooperation with Philippine Pediatric Society, Inc. (PPS) way back in 2004. Several CPG updates were then undertaken by the PAPP PCAP CPG Task Force from 2008 to 2016. Clinically-relevant research questions were answered with recent and current recommendations based on evidence from local and international data. The 2021 PCAP CPG initiative was envisioned in March 2018 upon the recommendations of the 2018 PAPP Board for the purpose of updating the evidence in the PCAP CPG 2016 clinical questions. This led to the collaboration of PAPP and PIDSP to develop this CPG. Individual members were identified from each society as content experts to form the Steering Committee along with a clinical epidemiologist and technical writer as review experts. The committee identified the scope and target end user of the CPG as well as additional clinical questions to be included in the 2021 update aside from the questions on the previous CPGs. Selected members from the two societies formed the Technical Working Group (TWG) who did the literature search, appraisal of evidences, and formulation of recommendations. These recommendations were then presented to the stakeholders who became part of the consensus panel. There was no identified conflict of interest among the CPG developers, TWG members and stakeholders. A survey to determine potential competing interests were conducted during the development of this CPG. This initiative was fully funded by the PAPP and PIDSP societies. The 2021 PCAP CPG significantly differs from the previous CPGs in several aspects. First, the current guideline is a consensus between two pediatric societies. Second, much of the literature review has been centered on meta-analyses or systematic reviews instead of individual studies. Finally, appraisal of published literature was based on Grading of Recommendations, Assessment, Development and Evaluation (GRADE) criteria. Such methodological differences may provide difficulties in defining evolution of care through the years. As identified in the previous CPG updates, there is lack of local data hence most of the evidences gathered came from international studies. The applicability of such data to the local setting needs to be critically assessed for its value and relevance. Corollary to this, several gaps in knowledge are identified and these may serve as a guide for future research.

Philippine guidelines on periodic health examination: Pediatric immunization

Executive Summary@#This Clinical Practice Guideline for the Periodic Health Examination (Pediatric Immunization) is an output from the joint undertaking of the Department of Health and National Institutes of Health-Institute of Clinical Epidemiology. This clinical practice guideline is a systematic synthesis of scientific evidence on immunization for the prevention of human papilloma virus (HPV) infection, influenza, typhoid fever, Japanese encephalitis, poliomyelitis, meningococcal infection, and Hepatitis A in the pediatric population. The CPG provides nine (9) recommendations on prioritized questions regarding the relevant vaccines for preventing these seven (7) diseases. Recommendations are based on the appraisal of the best available evidence on each of the eight identified clinical questions. The CPG is intended to be used by general practitioners and specialists in the primary care setting, policy makers, employers and administrators, allied health practitioners and even patients. The guideline development process followed the widely accepted Grading of Recommendations, Assessment, Development, and Evaluation or the GRADE approach including GRADE Adolopment, a systematic process of adapting evidence summaries and the GRADE Evidence to Decision (EtD) framework. 1,2 It includes 1) identification of critical questions and critical outcomes, 2) retrieval of current evidence, 3) assessment and synthesis of the evidence base for these critical questions, 4) formulation of draft recommendations, 5) convening of a multi-sectoral stakeholder panel to discuss values and preferences and assess the strength of the recommendations, and 6) planning for dissemination, implementation, impact evaluation and updating. The recommendations in this CPG shall hold and will be updated after 3 years or when new evidence arise.

Salud pública abierta: el camino para no dejar a nadie atrás

[RESUMEN]. En el contexto de la globalización, la salud pública requiere una cooperación continua entre todos los actores y un flujo de datos e información que facilite y apalanque esa cooperación. Sin embargo, existen aún diversas restricciones que limitan o imposibilitan el acceso a ella y su uso en beneficio de las sociedades. Debido a esto, se propone la adopción de la salud pública abierta y se exploran sus implicaciones y alcances. Se entiende por salud pública abierta los datos, la información y el conocimiento dirigidos a mejorar la salud pública, que se comparten y desarrollan a través de redes colaborativas sin restricciones de acceso y uso y con protección continua de la privacidad, seguridad y confidencialidad de los datos sensibles o que requieran especial protección.

[ABSTRACT]. In the context of globalization, public health requires continuous cooperation among all actors and a flow of data and information that facilitates and leverages that cooperation. However, there are still barriers that limit or prevent access to and use of public health for the benefit of societies. In this context, the adoption of open public health is proposed and its implications and scope are explored. Open public health is understood as data, information and knowledge aimed at improving public health, which are shared and developed through collaborative networks without restrictions on access and use and with continuous protection of privacy, security and confidentiality of sensitive data or data requiring special protection.

[RESUMO]. No contexto da globalização, a saúde pública requer a cooperação contínua entre todos os atores e um fluxo de dados e informações que facilite e aproveite da melhor forma essa cooperação. No entanto, ainda existem muitas restrições que limitam ou impedem o acesso à saúde pública e a sua utilização em benefício das sociedades. Por isso, propomos aqui a adoção da saúde pública aberta, explorando as suas implicações e possibilidades. A saúde pública aberta é entendida como o uso de dados, informações e conhecimentos para melhorar a saúde pública, compartilhados e desenvolvidos através de redes colaborativas, sem restrições de acesso ou utilização e com proteção contínua da privacidade, segurança e confidencialidade de dados sensíveis ou que precisem de proteção especial.

Ambiente virtual para treino de competências de comunicação na área da saúde: o caso do atendimento em farmácia para automedicação

Este artigo descreve um protótipo de Realidade Virtual destinado ao treino de competências técnicas e de comunicação dos estudantes de Ciências Farmacêuticas. Numa situação simulada, um humano virtual desempenha o papel de um paciente/doente que requer o apoio de um profissional numa farmácia, comunicando com este através de mensagens de texto. O estudante comunica com este personagem virtual escolhendo opções na interface da aplicação. Esta interface contém para cada situação: i) um conjunto de questões a colocar ao paciente, destinadas a esclarecer a sua situação de saúde, ou em alternativa, ii) um conjunto de respostas ou recomendações para os problemas dos pacientes, em última análise o medicamento e a posologia recomendados. Estes conjuntos contêm opções corretas e incorretas, tendo o estudante o propósito de alcançar o melhor desempenho possível, escolhendo sempre as corretas. A simulação decorre num cenário pré-gravado de uma farmácia real, no qual o paciente virtual está inserido. Este personagem virtual é capaz de exibir expressões faciais e tem movimentos naturais do corpo obtidos recorrendo à técnica de captura de movimentos. Referência Bibliográfica: Cláudio, Ana Paula [et al.] - Ambiente virtual para treino de competências de comunicação na área da saúde : o caso do atendimento em farmácia para automedicação. "Revista de Ciências da Computação" [Em linha]. ISSN 1646-6330 (Print) 2182-1801 (Online). Vol. 9, nº 9 (2014), p. 45-62

Febre Amarela: guia para profissionais de saúde

Este documento foi elaborado para auxiliar os profissionais de saúde que atuam nas unidades básicas localizadas nas regiões com surtos de febre amarela nos seguintes aspectos: Identificação e manejo clínico de casos suspeitos e confirmados. Identificação, encaminhamento e manejo clínico de casos graves. Medidas de controle e prevenção do surto. Identificação e manejo de eventos adversos pós-vacinação (EAPV). Conceitos sobre a vigilância da febre amarela. Este guia também contém informações básicas para que os gestores do Sistema Único de Saúde (SUS) e de unidades de saúde se preparem para receber pacientes com suspeita de febre amarela ou com reações adversas após a vacinação. O conteúdo deste guia pode ser reproduzido em partes ou no todo, de acordo com a conveniência e a necessidade de cada serviço de saúde, desde que citada a fonte.

Escala CAVIDACE: Evaluación de la Calidad de Vida de Personas con Daño Cerebral

Escala cuya finalidad es evaluar los resultados personales relacionados con la calidad de vida de adultos con daño cerebral e identificar el perfil de calidad de vida para la realización de planes individuales de apoyo, así como para la supervisión de los progresos y los resultados de los planes.

Estado de situación sobre el desayuno en España

Contiene: Recuerdo sobre la importancia del desayuno, el desayuno saludable, el desayuno en el mundo, datos actuales sobre el desayuno en España, el desayuno personalizado: desayuno en mujeres gestantes y lactantes, en niños y adolescentes, en adultos, en adultos mayores, desayuno sin lácteos por problemas asociados a su consumo, desayuno sin gluten.

Alimentos orgánicos disminuyen la incidencia de cáncer / Organic foods reduce the incidence of cancer

En todo el mundo, el número de casos nuevos de cáncer se estimó en 2012 en más de 14 millones,1,2 y el cáncer sigue siendo una de las principales causas de mortalidad en Francia. Entre los factores de riesgo ambientales para el cáncer, existen preocupaciones sobre la exposición a diferentes clases de pesticidas, en particular a través de la exposición ocupacional.3 Una revisión reciente4 concluyó que el papel de los pesticidas para el riesgo de cáncer no podía ponerse en duda dado el creciente cuerpo de evidencia que vincula el desarrollo del cáncer a la exposición a plaguicidas. Si bien las respuestas a dosis de tales moléculas o los posibles efectos de coctel no se conocen bien, se ha sugerido un aumento de los efectos tóxicos, incluso a bajas concentraciones de mezclas de pesticidas.5

Worldwide, the number of new cases of cancer was estimated in 2012 at more than 14 million, 1,2 and cancer remains one of the leading causes of death in France. Among the environmental risk factors for cancer, there are concerns about exposure to different kinds of pesticides, particularly through occupational exposure.3 A recent review4 concluded that the role of pesticides in cancer risk could not be put in place. doubt given the growing body of evidence linking the development of cancer to exposure to pesticides. While responses to doses of such molecules or possible cocktail effects are not well known, an increase in toxic effects has been suggested, even at low concentrations of pesticide mixtures.5

NeNe diccionario: Términos de neurología neonatal para padres

Diccionario que tiene como fin ayudar a las familias de los recién nacidos y lactantes pequeños con problemas neurológicos a comprender que les ocurre a sus hijos. Incluye textos con un lenguaje sencillo alejado de tecnicismos y apoyado en ilustraciones. Contiene: Anatomía y desarrollo del sistema nervioso, exploración neurológica del bebé, estudios diagnósticos e intervenciones terapéuticas, genética y herencia biológica, características y estabilidad del bebé, monitorización general, alteraciones del cráneo o de la cabeza, anomalías o malformaciones del cerebro, alteraciones de la función neurológica, infecciones del sistema nervioso central, hemorragias cerebrales, alteraciones por falta de oxígeno, alteraciones de los ojos, la visión y la audición, alteraciones de nervios periféricos, del músculo, las articulaciones o los huesos, alteraciones de la piel, cuidado del bebé y otros, índice de términos.

Dípteros y garrapatas: un problema de salud pública

Documento dirigido a farmacéuticos de oficina de farmacia y otros profesionales sanitarios, con información sobre los riesgos que representan para la salud pública, los dípteros (simúlidos, flebotomos y mosquitos) y las garrapatas existentes en la Comunidad de Madrid y el uso responsable de repelentes. Contiene información a la población sobre prevención de picaduras.

Un llamado ético a la inclusión de mujeres embarazadas en investigación: Reflexiones del Foro Global de Bioética en Investigación

El Foro Global de Bioética en Investigación (GFBR por sus siglas en inglés) se reunió el 3 y 4 de noviembre en Buenos Aires, Argentina, con el objetivo de discutir la ética de la investigación con mujeres embarazadas. El GFBR es una plataforma mundial que congrega a actores clave con el objetivo de promover la investigación realizada de manera ética, fortalecer la ética de la investigación en salud, particularmente en países de ingresos bajos y medios, y promover colaboración entre países del norte y del sur.a Los participantes en el GFBR provenientes de Latinoamérica incluyeron a eticistas, investigadores, miembros de comités de ética y representantes de autoridades sanitarias provenientes de Argentina, Brasil, Chile, Colombia, Ecuador, El Salvador, Guatemala, Honduras, Panamá, Perú, Nicaragua y la República Dominicana. Una legítima preocupación por la protección de las mujeres embarazadas y sus embriones o fetos ha llevado a la mayoría de los países de la Región de las Américas a limitar la realización de estudios con mujeres embarazadas exclusivamente a aquellos estudios específicos sobre el embarazo, y a requerir la exclusión sistemática de las mujeres embarazadas o de las mujeres que quedan embarazadas en el curso del estudio. Ciertamente, a lo largo de la historia de la ética de la investigación, se ha creído erróneamente que proteger a una población es sinónimo de excluirla de los estudios. Se sabe ahora que proceder así implica exponer a riesgos mucho mayores a la población que se busca proteger. El embarazo implica cambios fisiológicos sustantivos e impacta profundamente la manera como el cuerpo metaboliza los medicamentos. Sin embargo, por evitar hacer investigación con mujeres embarazadas, no se ha producido la evidencia científica necesaria para tomar decisiones sobre tratamientos e intervenciones preventivas con dosis eficaces y seguras para ellas y sus embriones o fetos. A manera de ilustración, en el 2001 había en los Estados Unidos apenas más de una docena de medicamentos aprobados para uso en el embarazo (1) y en el 2011 la Food and Drug Administration (FDA) aprobó por primera vez en 15 años un medicamento para su uso en el embarazo (2). Como consecuencia de no haber producido la evidencia necesaria, se pone en riesgo la salud de las mujeres embarazadas cada vez que se les da atención médica. Las mujeres embarazadas se enferman y las mujeres enfermas se embarazan, y no se sabe si los medicamentos que se les da son eficaces o siquiera seguros para ellas y sus embriones o fetos...