Pain as a disease in the new International Classification of Diseases (ICD-11): Latin American expert consensus.

Aims: Pain diagnoses in the 10th version of the International Classification of Diseases (ICD-10) did not adequately support the current management of pain. Therefore, we aimed to review the new 11th revision (ICD-11) in order to analyze its usefulness for the management, coding, research and education of chronic pain from a Latin American perspective. Methods: The Latin American Federation of Associations for the Study of Pain convened a meeting of pain experts in Lima, Peru. Pain specialists from 14 Latin American countries attended the consensus meeting. Results: In ICD-11, chronic pain is defined as pain that persists or recurs longer than 3 months and is subdivided into seven categories: chronic primary pain and six types of chronic secondary pain. Chronic primary pain is now considered a disease in itself, and not a mere symptom of an underlying disease. Conclusion: The novel definition and classification of chronic pain in ICD-11 is helpful for better medical care, research and health statistics. ICD-11 will improve chronic pain management in Latin American countries, for both the pain specialist and the primary care physician.

Chronic pain is one of the most frequent reasons for medical consultation in Latin America. In the tenth revision of the International Classification of Diseases and Related Health Problems (ICD-10), chronic pain was not adequately defined and individual pain diagnoses were poorly defined. For the first time in Latin America, a meeting of pain experts analyzed and reviewed the 11th version of the International Classification of Diseases (ICD-11), when the Latin America Federation of Associations for the Study of Pain organized a meeting of experts from 14 Latin American countries. In ICD-11, chronic pain is recognized as a biopsychosocial phenomenon and defined as pain that continues or returns for more than 3 months. It is split into seven types: chronic primary pain and six types of chronic secondary pain. In ICD-11, chronic primary pain is now considered a disease in itself, not a mere manifestation of other disease. Our article is the first to address the problems, challenges and benefits of using ICD-11 from a Latin American perspective. It will help to facilitate and disseminate the use of this new classification of chronic pain. This will improve chronic pain treatment, statistics, research and development of better health strategies for pain management in Latin America.

Conventional vs. diode laser stapedotomy: audiological outcomes and clinical safety.

PURPOSE: To compare the hearing results and clinical safety of patients undergoing stapes surgery with conventional technique and diode laser. METHODS: Retrospective observational study, which included patients treated with primary stapes surgery performed between January 2009 and January 2020. Three audiometric measurements (PTA, GAP and SDS) were evaluated as main results, evaluated by analysis of covariance (controlling the preoperative value). Intraoperative and postoperative complications were also analyzed. Outcomes were measured 6 months (± 1 month) after surgery. RESULTS: 153 cases were included, 97 operated with conventional technique and 56 with laser technique. Postoperative GAP ≤ 10 dB was obtained in 85.6% of the total sample, 82.5% in the conventional technique and 91.1% in the laser technique. Analysis of covariance showed no significant differences in the three surgery outcomes between the two groups (PTA, p = 0.277; GAP, p = 0.509 and SDS, p = 0.530). Regarding surgical complications, sensorineural damage was higher in the conventional technique group (p = 0.05). On the other hand, there were four cases of facial paresis, all in the laser group, three of them with the 980 nm laser. CONCLUSIONS: Stapedotomy offered a high percentage of hearing success in the two groups studied. There were no significant differences in audiometric result, but there was a differential presentation of complications, being more frequent sensorineural hearing loss in the conventional technique group and facial paresis in the laser group.

Relationship between hypovitaminosis D and sarcopenia in patients with stage 3 and 4 chronic kidney disease in Colombian patients.

BACKGROUND: Sarcopenia is a condition associated with aging and multiple medical conditions such as CKD and hypovitaminosis D. METHODS: An observational cross-sectional study was carried out, based on patients registered in a database of specialized nephrology consultation in the city of Manizales, Colombia. 101 patients over 18 years of age who had stage 3 or 4 CKD were included. RESULTS: The frequency of sarcopenia was 10.9%. No relationship was found between sarcopenia alone and serum vitamin D levels. However, when sarcopenia was categorized as severe there was a direct relationship with hypovitaminosis D. There was also a direct relationship between dynapenia and hypovitaminosis D. In addition, patients who had serum vitamin D levels above 40 ng/ml had better muscle performance, and, consequently, probably a lower risk of frailty. CONCLUSION: When patients, within their treatment, received vitamin D supplementation, no effect on muscle performance was observed.

[Ultrasound-accelerated thrombolysis. Initial experience in patients with contraindications to systemic thrombolysis]. / Trombólisis acelerada por ultrasonido. Experiencia inicial en pacientes con contraindicación para trombólisis sistémica.

Background: acute pulmonary embolism (APE) is a complex and potentially deadly entity, with a variable clinical course, considered the third cardiovascular cause of death. Its management varies according to the stratified risk from anticoagulation to reperfusion therapy, suggesting systemic thrombolysis as a first-choice strategy; however, in a large group of patients their use will be contraindicated, discouraged or will have failed, thus recommending as options in such cases endovascular therapies or surgical embolectomy. With the presentation of 3 clinical cases and a review of the literature, we seek to communicate our initial experience in the use of ultrasound-accelerated thrombolysis with the EKOS system and to investigate key elements for its understanding and application. Clinical cases: the cases of 3 patients with APE of high and intermediate risk with contraindications for systemic thrombolysis taken to accelerated thrombolysis therapy by ultrasound are discussed. They presented adequate clinical and hemodynamic evolution in the short term, achieving a rapid decrease in thrombolysis, systolic and mean pulmonary arterial pressure, improvement of right ventricular function and reduction of thrombotic burden. Conclusion: Ultrasound-accelerated thrombolysis is a novel pharmaco-mechanical therapy that combines the emission of ultrasonic waves with the infusion of a local thrombolytic agent, a strategy that, according to different trials and clinical registries, has a high success rate and a good safety profile.

Introducción: la tromboembolia pulmonar (TEP) aguda es una entidad compleja y potencialmente mortal, de curso clínico variable, considerada como la tercera causa cardiovascular de muerte. Su manejo varía de acuerdo con el riesgo estratificado desde anticoagulación hasta terapia de reperfusión, por lo que se sugiere como estrategia de primera elección la trombólisis sistémica; sin embargo, en un grupo amplio de pacientes su empleo estará contraindicado, desaconsejado o habrá fallado y se recomendarán como opciones en tales casos terapias endovasculares o embolectomía quirúrgica. A partir de la presentación de 3 casos clínicos y una revisión de la literatura, buscamos comunicar nuestra experiencia inicial en el uso de trombólisis acelerada por ultrasonido con sistema EKOS e indagar elementos claves para su entendimiento y aplicación. Caso clínico: se discuten los casos de 3 pacientes con TEP aguda de riesgo alto e intermedio con contraindicaciones para la trombólisis sistémica, llevados a terapia de trombólisis acelerada por ultrasonido, los cuales presentaron adecuada evolución clínica y hemodinámica a corto plazo, y lograron una rápida disminución de la presión arterial pulmonar sistólica y media, mejoría de función ventricular derecha y reducción de la carga trombótica. Conclusión: la trombólisis acelerada por ultrasonido es una terapia fármaco-mecánica novedosa que combina la emisión de ondas ultrasónicas con la infusión de un agente trombolítico local, estrategia que según diferentes ensayos y registros clínicos presenta una alta tasa de éxito y un buen perfil de seguridad.

An anti-infodemic virtual center for the Americas.

The Pan American Health Organization/World Health Organization (PAHO/WHO) Anti-Infodemic Virtual Center for the Americas (AIVCA) is a project led by the Department of Evidence and Intelligence for Action in Health, PAHO and the Center for Health Informatics, PAHO/WHO Collaborating Center on Information Systems for Health, at the University of Illinois, with the participation of PAHO staff and consultants across the region. Its goal is to develop a set of tools-pairing AI with human judgment-to help ministries of health and related health institutions respond to infodemics. Public health officials will learn about emerging threats detected by the center and get recommendations on how to respond. The virtual center is structured with three parallel teams: detection, evidence, and response. The detection team will employ a mixture of advanced search queries, machine learning, and other AI techniques to sift through more than 800 million new public social media posts per day to identify emerging infodemic threats in both English and Spanish. The evidence team will use the EasySearch federated search engine backed by AI, PAHO's knowledge management team, and the Librarian Reserve Corps to identify the most relevant authoritative sources. The response team will use a design approach to communicate recommended response strategies based on behavioural science, storytelling, and information design approaches.

El centro virtual contra la infodemia para la Región de las Américas de la Organización Panamericana de la Salud/Organización Mundial de la Salud (OPS/OMS) es un proyecto liderado por el Departamento de Evidencia e Inteligencia para la Acción en la Salud de la OPS y el Center for Health Informatics de la Universidad de Illinois, centro colaborador de la OPS/OMS en sistemas de información para la salud, con la participación de personal y consultores de la OPS en toda la Región. Su objetivo es crear un conjunto de herramientas que combinen inteligencia artificial (IA) y los criterios humanos para apoyar a los ministerios de salud y las instituciones relacionadas con la salud en la respuesta a la infodemia. Los funcionarios de salud pública recibirán formación sobre las amenazas emergentes detectadas por el centro y recomendaciones sobre cómo abordarlas. El centro virtual está estructurado en tres equipos paralelos: detección, evidencia y respuesta. El equipo de detección empleará una combinación de consultas mediante búsqueda avanzada, aprendizaje automático y otras técnicas de IA para evaluar más de 800 millones de publicaciones nuevas en las redes sociales al día con el fin de detectar amenazas emergentes en el ámbito de la infodemia tanto en inglés como en español. El equipo de evidencia hará uso del motor de búsqueda federado EasySearch y, con el apoyo de la IA, el equipo de gestión del conocimiento de la OPS y la red Librarian Reserve Corps, determinará cuáles son las fuentes autorizadas más pertinentes. El equipo de respuesta utilizará un enfoque vinculado al diseño para difundir las estrategias recomendadas sobre la base de las ciencias del comportamiento, la narración de historias y el diseño de la información.

O Centro Virtual Anti-Infodemia para as Américas (AIVCA, na sigla em inglês) da Organização Pan-Americana da Saúde/Organização Mundial da Saúde (OPAS/OMS) é um projeto liderado pelo Departamento de Evidência e Inteligência para a Ação em Saúde da OPAS e pelo Centro de Informática em Saúde da Universidade de Illinois, EUA (Centro Colaborador da OPAS/OMS para Sistemas de Informação para a Saúde), com a participação de funcionários e consultores da OPAS de toda a região. Seu objetivo é desenvolver um conjunto de ferramentas ­ combinando a inteligência artificial (IA) com o discernimento humano ­ para ajudar os ministérios e instituições de saúde a responder às infodemias. As autoridades de saúde pública aprenderão sobre as ameaças emergentes detectadas pelo centro e obterão recomendações sobre como responder. O centro virtual está estruturado com três equipes paralelas: detecção, evidência e resposta. A equipe de detecção utilizará consultas de pesquisa avançada, machine learning (aprendizagem de máquina) e outras técnicas de IA para filtrar mais de 800 milhões de novas postagens públicas nas redes sociais por dia, a fim de identificar ameaças infodêmicas emergentes em inglês e espanhol. A equipe de evidência usará o mecanismo de busca federada EasySearch, com apoio de IA, da equipe de gestão de conhecimento da OPAS e do Librarian Reserve Corps (LRC), para identificar as fontes abalizadas mais relevantes. A equipe de resposta usará uma abordagem de design para comunicar estratégias de resposta recomendadas com base em abordagens de ciência comportamental, narração de histórias e design da informação.

An anti-infodemic virtual center for the Americas

[ABSTRACT]. The Pan American Health Organization/ World Health Organization (PAHO/WHO) Anti-Infodemic Virtual Center for the Americas (AIVCA) is a project led by the Department of Evidence and Intelligence for Action in Health, PAHO and the Center for Health Informatics, PAHO/WHO Collaborating Center on Information Systems for Health, at the University of Illinois, with the participation of PAHO staff and consultants across the region. Its goal is to develop a set of tools—pairing AI with human judgment—to help ministries of health and related health institutions respond to infodemics. Public health officials will learn about emerging threats detected by the center and get recommendations on how to respond. The virtual center is structured with three parallel teams: detection, evidence, and response. The detection team will employ a mixture of advanced search que- ries, machine learning, and other AI techniques to sift through more than 800 million new public social media posts per day to identify emerging infodemic threats in both English and Spanish. The evidence team will use the EasySearch federated search engine backed by AI, PAHO’s knowledge management team, and the Librar- ian Reserve Corps to identify the most relevant authoritative sources. The response team will use a design approach to communicate recommended response strategies based on behavioural science, storytelling, and information design approaches.

[RESUMEN]. El centro virtual contra la infodemia para la Región de las Américas de la Organización Panamericana de la Salud/Organización Mundial de la Salud (OPS/OMS) es un proyecto liderado por el Departamento de Eviden- cia e Inteligencia para la Acción en la Salud de la OPS y el Center for Health Informatics de la Universidad de Illinois, centro colaborador de la OPS/OMS en sistemas de información para la salud, con la participación de personal y consultores de la OPS en toda la Región. Su objetivo es crear un conjunto de herramientas que combinen inteligencia artificial (IA) y los criterios humanos para apoyar a los ministerios de salud y las instituciones relacionadas con la salud en la respuesta a la infodemia. Los funcionarios de salud pública reci- birán formación sobre las amenazas emergentes detectadas por el centro y recomendaciones sobre cómo abordarlas. El centro virtual está estructurado en tres equipos paralelos: detección, evidencia y respuesta. El equipo de detección empleará una combinación de consultas mediante búsqueda avanzada, aprendizaje automático y otras técnicas de IA para evaluar más de 800 millones de publicaciones nuevas en las redes sociales al día con el fin de detectar amenazas emergentes en el ámbito de la infodemia tanto en inglés como en español. El equipo de evidencia hará uso del motor de búsqueda federado EasySearch y, con el apoyo de la IA, el equipo de gestión del conocimiento de la OPS y la red Librarian Reserve Corps, determinará cuáles son las fuentes autorizadas más pertinentes. El equipo de respuesta utilizará un enfoque vinculado al diseño para difundir las estrategias recomendadas sobre la base de las ciencias del comportamiento, la narración de historias y el diseño de la información.

[RESUMO]. O Centro Virtual Anti-Infodemia para as Américas (AIVCA, na sigla em inglês) da Organização Pan-Ameri- cana da Saúde/Organização Mundial da Saúde (OPAS/OMS) é um projeto liderado pelo Departamento de Evidência e Inteligência para a Ação em Saúde da OPAS e pelo Centro de Informática em Saúde da Uni- versidade de Illinois, EUA (Centro Colaborador da OPAS/OMS para Sistemas de Informação para a Saúde), com a participação de funcionários e consultores da OPAS de toda a região. Seu objetivo é desenvolver um conjunto de ferramentas — combinando a inteligência artificial (IA) com o discernimento humano — para ajudar os ministérios e instituições de saúde a responder às infodemias. As autoridades de saúde pública aprenderão sobre as ameaças emergentes detectadas pelo centro e obterão recomendações sobre como responder. O centro virtual está estruturado com três equipes paralelas: detecção, evidência e resposta. A equipe de detecção utilizará consultas de pesquisa avançada, machine learning (aprendizagem de máquina) e outras técnicas de IA para filtrar mais de 800 milhões de novas postagens públicas nas redes sociais por dia, a fim de identificar ameaças infodêmicas emergentes em inglês e espanhol. A equipe de evidência usará o mecanismo de busca federada EasySearch, com apoio de IA, da equipe de gestão de conhecimento da OPAS e do Librarian Reserve Corps (LRC), para identificar as fontes abalizadas mais relevantes. A equipe de resposta usará uma abordagem de design para comunicar estratégias de resposta recomendadas com base em abordagens de ciência comportamental, narração de histórias e design da informação.

An anti-infodemic virtual center for the Americas / Un centro virtual contra la infodemia para la Región de las Américas / Um centro virtual anti-infodemia para as Américas

ABSTRACT The Pan American Health Organization/World Health Organization (PAHO/WHO) Anti-Infodemic Virtual Center for the Americas (AIVCA) is a project led by the Department of Evidence and Intelligence for Action in Health, PAHO and the Center for Health Informatics, PAHO/WHO Collaborating Center on Information Systems for Health, at the University of Illinois, with the participation of PAHO staff and consultants across the region. Its goal is to develop a set of tools—pairing AI with human judgment—to help ministries of health and related health institutions respond to infodemics. Public health officials will learn about emerging threats detected by the center and get recommendations on how to respond. The virtual center is structured with three parallel teams: detection, evidence, and response. The detection team will employ a mixture of advanced search queries, machine learning, and other AI techniques to sift through more than 800 million new public social media posts per day to identify emerging infodemic threats in both English and Spanish. The evidence team will use the EasySearch federated search engine backed by AI, PAHO's knowledge management team, and the Librarian Reserve Corps to identify the most relevant authoritative sources. The response team will use a design approach to communicate recommended response strategies based on behavioural science, storytelling, and information design approaches.

RESUMEN El centro virtual contra la infodemia para la Región de las Américas de la Organización Panamericana de la Salud/Organización Mundial de la Salud (OPS/OMS) es un proyecto liderado por el Departamento de Evidencia e Inteligencia para la Acción en la Salud de la OPS y el Center for Health Informatics de la Universidad de Illinois, centro colaborador de la OPS/OMS en sistemas de información para la salud, con la participación de personal y consultores de la OPS en toda la Región. Su objetivo es crear un conjunto de herramientas que combinen inteligencia artificial (IA) y los criterios humanos para apoyar a los ministerios de salud y las instituciones relacionadas con la salud en la respuesta a la infodemia. Los funcionarios de salud pública recibirán formación sobre las amenazas emergentes detectadas por el centro y recomendaciones sobre cómo abordarlas. El centro virtual está estructurado en tres equipos paralelos: detección, evidencia y respuesta. El equipo de detección empleará una combinación de consultas mediante búsqueda avanzada, aprendizaje automático y otras técnicas de IA para evaluar más de 800 millones de publicaciones nuevas en las redes sociales al día con el fin de detectar amenazas emergentes en el ámbito de la infodemia tanto en inglés como en español. El equipo de evidencia hará uso del motor de búsqueda federado EasySearch y, con el apoyo de la IA, el equipo de gestión del conocimiento de la OPS y la red Librarian Reserve Corps, determinará cuáles son las fuentes autorizadas más pertinentes. El equipo de respuesta utilizará un enfoque vinculado al diseño para difundir las estrategias recomendadas sobre la base de las ciencias del comportamiento, la narración de historias y el diseño de la información.

RESUMO O Centro Virtual Anti-Infodemia para as Américas (AIVCA, na sigla em inglês) da Organização Pan-Americana da Saúde/Organização Mundial da Saúde (OPAS/OMS) é um projeto liderado pelo Departamento de Evidência e Inteligência para a Ação em Saúde da OPAS e pelo Centro de Informática em Saúde da Universidade de Illinois, EUA (Centro Colaborador da OPAS/OMS para Sistemas de Informação para a Saúde), com a participação de funcionários e consultores da OPAS de toda a região. Seu objetivo é desenvolver um conjunto de ferramentas — combinando a inteligência artificial (IA) com o discernimento humano — para ajudar os ministérios e instituições de saúde a responder às infodemias. As autoridades de saúde pública aprenderão sobre as ameaças emergentes detectadas pelo centro e obterão recomendações sobre como responder. O centro virtual está estruturado com três equipes paralelas: detecção, evidência e resposta. A equipe de detecção utilizará consultas de pesquisa avançada, machine learning (aprendizagem de máquina) e outras técnicas de IA para filtrar mais de 800 milhões de novas postagens públicas nas redes sociais por dia, a fim de identificar ameaças infodêmicas emergentes em inglês e espanhol. A equipe de evidência usará o mecanismo de busca federada EasySearch, com apoio de IA, da equipe de gestão de conhecimento da OPAS e do Librarian Reserve Corps (LRC), para identificar as fontes abalizadas mais relevantes. A equipe de resposta usará uma abordagem de design para comunicar estratégias de resposta recomendadas com base em abordagens de ciência comportamental, narração de histórias e design da informação.

[Public health and digital interdependence: technological evolution, technological sustainability, and the user revolutionSaúde pública e a interdependência digital: evolução tecnológica, sustentabilidade tecnológica e a revolução do usuário]. / Salud pública y la interdependencia digital: evolución tecnológica, sostenibilidad tecnológica y la revolución del usuario.

The "technological revolution in the health sector" resulting from the boom in the use of information and communications technologies (ICT) during the COVID-19 pandemic may, in fact, be due to a revolution among users whose close relationship with ICT has mobilized health systems, with the pandemic as a turning point. This article proposes a conceptual model of technological evolution and revolution among users, with transitions from acceptance of digital health to an understanding of its potential, and from the sustainability of digital health to trust in its various applications and governance. This requires clear approaches and agreements between the different sectors of the health system in terms of management, infrastructure, policies, and training, among other areas, focused on the user revolution and ensuring that no one is left behind.This article aims to conceptualize the process of evolution and revolution in ICT, as it applies to health in the context of the COVID-19 pandemic.

Argumenta-se que a chamada "revolução tecnológica no setor da saúde", devido ao boom no uso das tecnologias da informação e comunicação (TIC) ocorrido durante a pandemia de COVID-19, na verdade se deve a uma revolução do usuário que, devido à sua estreita relação com as TIC e no ponto de inflexão da pandemia, mobilizou os sistemas de saúde. Nesse sentido, propõe-se um modelo conceitual de evolução e revolução tecnológica dos usuários, com transições da aceitação da saúde digital para a compreensão do seu potencial, bem como da sustentabilidade da saúde digital para a confiança em suas diversas aplicações e governanças. Isso requer enfoques e acordos claros entre os diferentes setores do sistema de saúde em termos de gestão, infraestrutura, políticas e capacitação, entre outros, com foco na revolução do usuário e assegurando que ninguém fique para trás. Este artigo tem como objetivo conceitualizar o processo de evolução e revolução das TIC aplicadas à saúde no contexto da pandemia de COVID-19.

3D-Printed Quasi-Cylindrical Bragg Reflector to Boost the Gain and Directivity of cm- and mm-Wave Antennas.

We demonstrate a concept for a large enhancement of the directivity and gain of readily available cm- and mm-wave antennas, i.e., without altering any property of the antenna design. Our concept exploits the high reflectivity of a Bragg reflector composed of three bilayers made of transparent materials. The cavity has a triangular aperture in order to resemble the idea of a horn-like, highly directive antenna. Importantly, we report gain enhancements of more than 400% in relation to the gain of the antenna without the Bragg structure, accompanied by a highly directive radiation pattern. The proposed structure is cost-effective and easy to fabricate with 3D-printing. Our results are presented for frequencies within the conventional WiFi frequencies, based on IEEE 802.11 standards, thus, enabling easily implementation by non-experts and needing only to be placed around the antenna to improve the directivity and gain of the signal.

Salud pública y la interdependencia digital: evolución tecnológica, sostenibilidad tecnológica y la revolución del usuario

[RESUMEN]. Se plantea que la llamada “revolución tecnológica en el sector salud”, debido al auge del uso de las tecnologías de la información y comunicaciones (TIC) que ocurrió durante la pandemia de COVID-19, se debe, en verdad, a una revolución del usuario que, por su estrecha relación con las TIC y en el punto de inflexión de la pandemia, ha movilizado a los sistemas de salud. Al respecto, se plantea un modelo conceptual de evolución y revolución tecnológica de los usuarios, con transiciones de la aceptación de la salud digital al entendimiento de su potencial, así como de la sostenibilidad de la salud digital a la confianza en sus diversas aplicaciones y gobernanzas. Lo anterior requiere de enfoques y acuerdos claros entre los diferentes sectores del sistema de salud en materia de gerencia, infraestructura, políticas y capacitación, entre otros, centrados en la revolución del usuario y asegurando no dejar a nadie atrás. El presente artículo pretende conceptualizar el proceso de evolución y revolución de las TIC aplicadas a la salud en el contexto de la pandemia de COVID-19.

[ABSTRACT]. The "technological revolution in the health sector" resulting from the boom in the use of information and communications technologies (ICT) during the COVID-19 pandemic may, in fact, be due to a revolution among users whose close relationship with ICT has mobilized health systems, with the pandemic as a turning point. This article proposes a conceptual model of technological evolution and revolution among users, with transitions from acceptance of digital health to an understanding of its potential, and from the sustainability of digital health to trust in its various applications and governance. This requires clear approaches and agreements between the different sectors of the health system in terms of management, infrastructure, policies, and training, among other areas, focused on the user revolution and ensuring that no one is left behind. This article aims to conceptualize the process of evolution and revolution in ICT, as it applies to health in the context of the COVID-19 pandemic.

[RESUMO]. Argumenta-se que a chamada “revolução tecnológica no setor da saúde”, devido ao boom no uso das tecnologias da informação e comunicação (TIC) ocorrido durante a pandemia de COVID-19, na verdade se deve a uma revolução do usuário que, devido à sua estreita relação com as TIC e no ponto de inflexão da pandemia, mobilizou os sistemas de saúde. Nesse sentido, propõe-se um modelo conceitual de evolução e revolução tecnológica dos usuários, com transições da aceitação da saúde digital para a compreensão do seu potencial, bem como da sustentabilidade da saúde digital para a confiança em suas diversas aplicações e governanças. Isso requer enfoques e acordos claros entre os diferentes setores do sistema de saúde em termos de gestão, infraestrutura, políticas e capacitação, entre outros, com foco na revolução do usuário e assegurando que ninguém fique para trás. Este artigo tem como objetivo conceitualizar o processo de evolução e revolução das TIC aplicadas à saúde no contexto da pandemia de COVID-19.

Toward a holistic definition for Information Systems for Health in the age of digital interdependence.

The article's main objective is to propose a new definition for Information Systems for Health, which is characterized by the identification and involvement of all the parts of a complex and interconnected process for data collection and decision-making in public health in the information society. The development of the concept was through a seven-step process including document analysis, on-site and virtual sessions for experts, and an online survey of broader health professionals. This new definition seeks to provide a holistic view, process, and approach for managing interoperable applications and databases that ethically considers open and free access to structured and unstructured data from different sectors, strategic information, and information and communication technology (ICT) tools for decision-making for the benefit of public health. It also supports the monitoring of the Sustainable Development Goals and the implementation of universal access to health and universal health coverage as well as Health in All Policies as an approach to promote health-related policies across sectors. Information Systems for Health evolves from preconceptions of health information systems to an integrated and multistakeholder effort that ensures better care and better policy-making and decision-making.

El objetivo principal de este artículo es proponer una nueva definición de los sistemas de información para la salud, que se caracterizan por la identificación y la participación de todas las partes involucradas en un complejo proceso interconectado de recopilación de datos y toma de decisiones en el ámbito de la salud pública en la sociedad de la información. El concepto se desarrolló en un proceso de siete pasos que incluyó el análisis de documentos, sesiones presenciales y virtuales con expertos y una encuesta en línea a profesionales de la salud en general. Esta nueva definición procura ofrecer un criterio holístico, un proceso y un enfoque para la gestión de bases de datos y aplicaciones interoperables que considere desde un punto de vista ético el acceso abierto y gratuito a datos estructurados y no estructurados de diferentes sectores, información estratégica y herramientas de tecnologías de la información y de la comunicación (TIC) para la toma de decisiones en beneficio de la salud pública. También brinda apoyo al seguimiento de los Objetivos de Desarrollo Sostenible y la ejecución del acceso universal a la salud y la cobertura universal de salud, así como la salud en todas las políticas como iniciativa para promover políticas relacionadas con la salud en todos los sectores. El concepto de sistemas de información para la salud implica una evolución desde lo que se consideraba anteriormente sistemas de información de salud hacia un esfuerzo integrado por parte de varios interesados directos que garantiza una mejora en la atención, la formulación de políticas y la toma de decisiones.

O principal objetivo deste artigo é propor uma nova definição para Sistemas de Informação em Saúde, que são caracterizados pela identificação e participação de todas as partes de um processo complexo e interconectado para a coleta de dados e tomada de decisão em saúde pública na sociedade da informação. O conceito foi desenvolvido por um processo de sete passos incluindo análise de documentos, sessões presenciais e virtuais com especialistas e uma pesquisa on-line com profissionais de saúde generalistas. A nova definição busca oferecer uma visão, um processo e uma abordagem holística para gerenciar aplicativos e bases de dados interoperáveis que consideram eticamente o acesso aberto e gratuito a dados estruturados e não estruturados de diferentes setores, informações estratégicas e ferramentas de tecnologia da informação e comunicação (TIC) para tomadas de decisão em prol da saúde pública. Também sustenta o monitoramento dos Objetivos de Desenvolvimento Sustentável e a implementação do acesso universal à saúde e da cobertura universal de saúde, assim como a Saúde em Todas as Políticas como uma abordagem para promover políticas relacionadas à saúde em vários setores. Os Sistemas de Informação em Saúde evoluíram de pré-conceitos dos sistemas de informação de saúde para um esforço integrado e com muitas partes interessadas, assegurando melhor cuidado, formulação de políticas e tomada de decisão.

Toward a holistic definition for Information Systems for Health in the age of digital interdependence

[ABSTRACT]. The article’s main objective is to propose a new definition for Information Systems for Health, which is characterized by the identification and involvement of all the parts of a complex and interconnected process for data collection and decision-making in public health in the information society. The development of the concept was through a seven-step process including document analysis, on-site and virtual sessions for experts, and an online survey of broader health professionals. This new definition seeks to provide a holistic view, process, and approach for managing interoperable applications and databases that ethically considers open and free access to structured and unstructured data from different sectors, strategic information, and information and communication technology (ICT) tools for decision-making for the benefit of public health. It also supports the monitoring of the Sustainable Development Goals and the implementation of universal access to health and universal health coverage as well as Health in All Policies as an approach to promote health-related policies across sectors. Information Systems for Health evolves from preconceptions of health information systems to an integrated and multistakeholder effort that ensures better care and better policy-making and decision-making.

[RESUMEN]. El objetivo principal de este artículo es proponer una nueva definición de los sistemas de información para la salud, que se caracterizan por la identificación y la participación de todas las partes involucradas en un complejo proceso interconectado de recopilación de datos y toma de decisiones en el ámbito de la salud pública en la sociedad de la información. El concepto se desarrolló en un proceso de siete pasos que incluyó el análisis de documentos, sesiones presenciales y virtuales con expertos y una encuesta en línea a profesionales de la salud en general. Esta nueva definición procura ofrecer un criterio holístico, un proceso y un enfoque para la gestión de bases de datos y aplicaciones interoperables que considere desde un punto de vista ético el acceso abierto y gratuito a datos estructurados y no estructurados de diferentes sectores, información estratégica y herramientas de tecnologías de la información y de la comunicación (TIC) para la toma de decisiones en beneficio de la salud pública. También brinda apoyo al seguimiento de los Objetivos de Desarrollo Sostenible y la ejecución del acceso universal a la salud y la cobertura universal de salud, así como la salud en todas las políticas como iniciativa para promover políticas relacionadas con la salud en todos los sectores. El concepto de sistemas de información para la salud implica una evolución desde lo que se consideraba anteriormente sistemas de información de salud hacia un esfuerzo integrado por parte de varios interesados directos que garantiza una mejora en la atención, la formulación de políticas y la toma de decisiones.

[RESUMO]. O principal objetivo deste artigo é propor uma nova definição para Sistemas de Informação em Saúde, que são caracterizados pela identificação e participação de todas as partes de um processo complexo e interconectado para a coleta de dados e tomada de decisão em saúde pública na sociedade da informação. O conceito foi desenvolvido por um processo de sete passos incluindo análise de documentos, sessões presenciais e virtuais com especialistas e uma pesquisa on-line com profissionais de saúde generalistas. A nova definição busca oferecer uma visão, um processo e uma abordagem holística para gerenciar aplicativos e bases de dados interoperáveis que consideram eticamente o acesso aberto e gratuito a dados estruturados e não estruturados de diferentes setores, informações estratégicas e ferramentas de tecnologia da informação e comunicação (TIC) para tomadas de decisão em prol da saúde pública. Também sustenta o monitoramento dos Objetivos de Desenvolvimento Sustentável e a implementação do acesso universal à saúde e da cobertura universal de saúde, assim como a Saúde em Todas as Políticas como uma abordagem para promover políticas relacionadas à saúde em vários setores. Os Sistemas de Informação em Saúde evoluíram de pré-conceitos dos sistemas de informação de saúde para um esforço integrado e com muitas partes interessadas, assegurando melhor cuidado, formulação de políticas e tomada de decisão.

Desgaste proteico energético en pacientes con enfermedad renal crónica en estadios III a IV en Caldas, Colombia / Protein Energy Wasting in Patients with Chronic Renal Disease in Stage III to IV Caldas (Colombia)

Resumen Introducción: la enfermedad renal crónica (ERC) es un problema de salud mundial con una prevalencia aproximada del 7,2 % en países desarrollados y del 10 % en todo el mundo; además, es un factor independiente de morbilidad y riesgo cardiovascular que se caracteriza por la pérdida progresiva de la función renal. Objetivo: evaluar la frecuencia de desgaste proteico energético (DPE) en pacientes con ERC en estadios III a IV. Materiales y métodos: estudio descriptivo y de corte transversal. Se realizó una evaluación de los registros de las base de datos de la Sociedad Internacional de Nutrición y Metabolismo Renal sobre pacientes con ERC que contaran con variables sociodemográficas, bioquímicas, valoración global subjetiva (VGS) y medidas antropométricas para el diagnóstico de DPE. Resultados: de 200 pacientes revisados en consulta externa de Nefrología, 60 cumplieron con los criterios de inclusión. El promedio de edad fue de 68,4 años, con una media de tasa de filtración glomerular (TFG) de 47,1 mL/min. Respecto a la ERC, el 61,66 % (n=37) de los participantes fue clasificado en estadio IIIa; el 31,6 % (n=19), en estadio IIIb, y el 6,66 % (n=4), en estadio IV. Ninguno de los pacientes cumplió con los criterios para el DPE. La evaluación de la VGS mostró que el 53,33 % (n=32) de los pacientes estaba en categoría VGS-A (bien nutridos), el 45 % (n=27) en VGS-B (malnutrición moderada) y solo un paciente en VGS-C (malnutrición grave). La mayor proporción de pacientes con bajos niveles de albúmina y colesterol estuvo en pacientes con ERC en estadio IIIb, y los pacientes con índice de masa corporal <23, en estadios IIIb y IV. Conclusión: según los criterios de la Sociedad Internacional de Nutrición y Metabolismo Renal, ningún paciente presentó DPE.

Abstract Introduction: Chronic kidney disease (CKD) is a condition that is recognized as a global health problem and has an approximate prevalence of 7.2% in developed countries, and 10% in the world population, it is also an independent factor of cardiovascular morbidity and risk characterized by progressive loss of kidney function. Objective: To evaluate the frequency of DPE in patients with CKD stages III to IV. Methods: Descriptive, cross-sectional study. Evaluation of a database of patients with CKD, which will have sociodemographic, biochemical variables, Subjective Global Assessment (VGS), and anthropometric measures, for the diagnosis of DPE of the International Society for Nutrition and Renal Metabolism. Results: Of 200 reviewed patients from the Nephrology outpatient clinic, 60 met the inclusion criteria. The average age was 68.4 years, with a mean glomerular filtration rate (GFR) of 47.1ml / min. Regarding CKD, 61.66% (37) of the patients classified in stage IIIa, 31.6% (19) in stage IIIb, and 6.66% (4) in stage IV. None of the patients met the criteria for DPE. The VGS evaluation showed that 53.33% (32) of the patients were in the VGS A category (well nourished), 45% (27) VGS B (moderate malnutrition) and only one patient was classified as VGS C (severe malnutrition). The highest proportion of patients with low levels of albumin and cholesterol was in patients with CKD stage IIIb, and patients with BMI less than 23 in stages IIIb and IV. Conclusion: According to the criteria of the International Society for Renal Nutrition and Metabolism, no patient had DPE. outpatient clinic in Caldas, with CKD stages III to IV-. METHODS: Descriptive, cross-sectional study. Evaluation of a database of patients with CKD, which will have sociodemographic, biochemical variables, Subjective Global Assessment (SGA), and anthropometric measures, for the diagnosis of PEW of the International Society for Nutrition and Renal Metabolism. RESULTS: Of200 reviewed patients from the Nephrology outpatient clinic, 60 met the inclusion criteria. The average age was 68.4 years, with a mean glomerular filtration rate (GFR) of 47.1ml / min. Regarding CKD, 61.66% (37) of the patients were classified in stage IIIa, 31.6% (19) in stage IIIb, and 6.66% (4) in stage IV. None of the patients met the criteria for PEW. The SGA evaluation showed that 53.33% (32) of the patients were in SGAA category (well nourished), 45% (27) SGA B (moderate malnutrition) and only one patient was classified as SGA C (severe malnutrition). The highest proportion of patients with low albumin and cholesterol levels was in patients with CKD in stage IIIb, and patients with BMI less than 23 in stages IIIb and IV. Conclusion: According to the criteria of the International Society for Nutrition and Renal Metabolism, no patient had PEW.

Repeatability of material parameter extraction of liquids from transmission terahertz time-domain measurements.

Recently, many research groups worldwide have reported on the THz properties of liquids. Often these parameters, i.e., refractive index and absorption coefficient, are determined using liquids in cuvettes and terahertz time-domain spectroscopy. Here, we discuss the measurement process and determine how repeatable such measurements and the data extraction are using rapeseed oil as a sample. We address system stability, cuvette positioning, cuvette cleaning and cuvette assembly as sources affecting the repeatability. The results show that system stability and cuvette assembly are the most prominent factors limiting the repeatability of the THz measurements. These findings suggest that a single cuvette with precise positioning and thorough cleaning of the cuvette delivers the best discrimination among different liquid samples. Furthermore, when using a single cuvette and measurement systems of similar stability, the repeatability calculated based on several consecutive measurements is a good estimate to tell whether samples can be discriminated.

Bioelectrical impedance analysis and dual x-ray absorptiometry agreement for skeletal muscle mass index evaluation in sarcopenia diagnosis.

BACKGROUND: All definitions for diagnosing sarcopenia include the estimation of muscle mass. This can be made using bioelectrical impedance analysis (BIA) or dual x-ray absorptiometry (DXA). BIA is a portable and inexpensive method suitable for clinical settings, while DXA is cumbersome, more expensive and less available. OBJECTIVES: To evaluate the interchangeability of both techniques for skeletal muscle mass index (SMI) estimation, and assess whether the two methods are comparable for the diagnosis of sarcopenia. APPROACH: Prospective, cross-sectional study. SETTING: Faculty for Health Sciences, Universidad de Caldas, Colombia. PARTICIPANTS: Seventy-two subjects aged 65-80 years were recruited. MEASUREMENTS: BIA and DXA for SMI estimation and sarcopenia diagnoses using the definition of the European Working Group on Sarcopenia in Older People (EWGSOP). Of the 72 patients, 28 were diagnosed with sarcopenia by BIA and corroborated by DXA were included in the study. To establish the agreement between techniques, the intraclass correlation coefficient and the concordance correlation coefficient were calculated. A Bland-Altman plot evaluated the agreement. To evaluate agreement on the diagnosis of sarcopenia, a Cohen's kappa test was performed. MAIN RESULTS: Agreement between SMI by BIA and DXA was good according to the intraclass correlation coefficient (ICC 0.7 95% CI 0.5 to 0.8) but poor when the concordance correlation coefficient was used (CCC 0.4 was calculated 95% CI 0.3 to 0.5). The Bland-Altman analysis showed a clinically unacceptable discrepancy between the methods; the confidence intervals were too wide; the difference between methods tends to get larger as the average increases and the scatter around the bias line get larger as the average gets higher. Cohen's kappa test was 0.2 (SEE: 0.1). SIGNIFICANCE: The agreement between BIA and DXA was weak. We concluded that, in this studied population, the methods were not interchangeable. Results may improve if a specific formula in a greater sample size is used.

Evaluación de la percepción musical por estimulación acústica vs. eléctrica / Evaluation of musical perception by acoustic vs. electrical stimulation

Objetivo: evaluar las diferencias en la percepción musical entre la estimulación sonora eléctrica frente a la acústica. Materiales y métodos: se recolectó información de pacientes adultos con implante coclear unilateral, con oído contralateral sano o hipoacusia leve y con un tiempo de rehabilitación auditiva mayor a 12 meses. Se les aplicaron escalas de reconocimiento musical, de calidad de vida Glasgow Benefit Inventory (GBI), identificación de tono, ritmo, instrumentos y canciones. Resultados y conclusiones: se recolectaron datos de 6 pacientes con edades entre 37-73 años, promedio de tonos puros (PTA, por sus siglas en inglés) en oído sano <40 dB y porcentaje de máxima discriminación (SDS, por sus siglas en inglés): 100 % sin cambios en el postoperatorio. El oído implantado con un rango de PTA postoperatorio entre 40 y 58,3 dB y SDS entre 70-90 %. Se aplicó la escala GBI, en donde la mayoría de los pacientes obtuvieron resultados positivos con un rango entre +41 y -13. La mayoría de los pacientes aumentaron la frecuencia de escucha musical post-implantación (4/6 pacientes). La mitad de los pacientes reportaron mejoría en el papel que desempeña la música en sus vidas. En el reconocimiento del tono y del ritmo en el oído implantado se encontraron resultados similares posterior a la implantación con respecto al oído sano, con medianas de 17/20 frente a 16/20 en patrones tonales y 18,5/20 frente a 18/20 en patrones rítmicos. El reconocimiento de las canciones fue mejor con la letra que sin la letra en el oído implantado (8/8 frente a 7/8, respectivamente). El reconocimiento de instrumentos en el oído implantado fue 4,5/8 instrumentos frente a 7,5/8 en el oído sano.

Objective: To evaluate the differences in musical perception between electrical and acoustic sound stimulation. Materials and methods: Adult patients with unilateral cochlear implant, healthy or mild hearing loss in the contralateral ear and rehabilitation time greater than 12 months were evaluated. Musical recognition scales, quality of life Glasgow Benefit Inventory (GBI) and identification of tone, rhythm, instruments, and songs were applied. Results and conclusions: 6 patients were collected, ages between 37-73 years, healthy ear with a pure tone average (PTA) <40 dB, speech discrimination score (SDS): 100 % without changes in the postoperative period. The Implanted ear with average PTA between 40­58.3 dB and SDS between 70-90 % post-implantation. The GBI scale was applied where most of the patients obtained positive results, with a range between +41 and -13. Most of the patients improved the frequency of music-listening after implantation (4/6 patients). Half of the patients reported improvement in the role music plays in their lives. In the recognition of the tone and rhythm in the implanted ear, similar results were found after the implantation with respect to the healthy ear, with medians of 17/20 vs. 16/20 in tonal patterns and 18.5/20 vs. 18/20 in rhythmic patterns. The recognition of the songs was better with the lyrics than without the lyrics in the implanted ear, with medians of 8/8 vs. 7/8. The recognition of instruments in the implanted ear was 4.5/8 vs. 7.5/8 in the healthy ear.

Puntos de corte provisionales para el diagnóstico de sarcopenia en ancianos de Caldas, Colombia / Provisional cut-off points for the diagnosis of sarcopenia in elderly people from Caldas (Colombia)

Introducción. La sarcopenia es la disminución de masa muscular y la consecuente reducción del rendimiento y de la función física. Su aparición puede ser indicativa de riesgo de otras condiciones en los ancianos, y su diagnóstico requiere la comparación con los datos sobre la composición corporal de la población joven sana para establecer valores de referencia de la disminución de la masa muscular. Objetivo. Establecer puntos provisionales de corte recolectados mediante bioimpedancia eléctrica para el diagnóstico de sarcopenia en ancianos caldenses a partir de los datos de la composición muscular esquelética de jóvenes. Materiales y métodos. Se utilizaron las mediciones de la composición corporal de jóvenes sanos entre los 18 y los 35 años de edad tomadas mediante bioimpedancia eléctrica con base en las cuales se estableció el índice de masa muscular esquelética. Se aplicó la prueba de Kolmogorov-Smirnov para evaluar la normalidad de los datos y se estableció el promedio de dicho índice con sus desviaciones estándar tanto para hombres como para mujeres. Resultados. A partir de estos datos, se estableció como bajo un índice de masa muscular esquelética con un valor de dos desviaciones estándar por debajo de la media del índice en jóvenes. En las mujeres el valor fue de 6,42 kg/m2 y, en hombres, de 8,39 kg/m2. Conclusión. Estos valores son similares a los determinados por algunos autores en población asiática, lo que evidencia que esta tiene características de composición corporal similares a la población de estudio. Hasta donde se sabe, este es el primer estudio que ofrece una descripción de la composición corporal muscular esquelética en jóvenes colombianos y establece puntos de corte para el diagnóstico de sarcopenia en ancianos de esta región centro-andina del país.

Introduction: Sarcopenia is defined as a decrease in muscle mass associated with the reduction of performance and physical function. It is an indicator of adverse outcomes in elderly people. Its diagnosis requires body composition data of healthy young population to establish reference values of low muscle mass. Objective: To establish a provisional cut-off point for sarcopenia in the elderly population from Caldas based on the skeletal muscle composition data of young people using electric bioimpedance. Materials and methods: Body composition data from healthy young people (18 to 35 years old) were used to calculate the skeletal muscle mass index. The Kolmogorov-Smirnov test was applied to evaluate the normality of the data and then the average and standard deviation of muscle mass index were established for both men and women. Results: Based on these data, we established as low muscle mass a skeletal muscle mass index of two standard deviations below the mean of the muscular mass index in young people. The cut-off points were 6.42 kg/m2 and 8.39 kg/m2 for women and men, respectively. Conclusion: This is the first study that offers a description of skeletal muscle body composition in young Colombians and provides cut-off points for the diagnosis of sarcopenia in the elderly population from the Central-Andean region. The data gathered are similar to those proposed by some Asian authors, which shows that the population of this Colombian region has body composition characteristics similar to those from Asia.

Ultralow chirp photonic crystal fiber Mach-Zehnder interferometer.

A photonic crystal fiber Mach-Zehnder interferometer design was optimized to obtain high performance and ultralow chirp. Two long-period gratings were used to excite the cladding modes, and the rich structure of the cladding was tailored to obtain a slightly chirped free spectral range, as required by the Telecommunication Standardization Sector of the International Telecommunication Union (ITU-T) Norm G.694.1. Finally, a fabrication tolerance analysis was performed. The advantages of the proposed device are an ultralow chirp, high bandwidth, and fabrication robustness tolerance.

[Infoxication in health. Health information overload on the Internet and the risk of important information becoming invisible]. / Infoxicación en salud. La sobrecarga de información sobre salud en la web y el riesgo de que lo importante se haga invisible.

OBJECTIVE: The objectives of this study were to: 1) raise awareness of the volume of quality health information on the Internet; 2) explore perceptions of information professionals with regard to the use of qualified sources for health decision-making; and 3) make recommendations that facilitate strengthening health worker capacities and institutional competencies related to digital literacy. METHODS: A non-experimental, descriptive cross-sectional study was conducted with a non-probability sample of 32 information professionals from nine countries. Internet information was compiled on the volume of content in Internet tools, social networks, and health information sources. Searches in English and Spanish were carried out using the keywords Ebola, Zika, dengue, chikungunya, safe food, health equity, safe sex, and obesity. Finally, information was obtained on opportunities for formal education on the subjects of digital literacy, information management, and other related topics. RESULTS: Selecting only four diseases with a high impact on public health in May 2016 and averaging minimum review time for each information product, it would take more than 50 years without sleeping to consult everything that is published online about dengue, Zika, Ebola, and chikungunya. CONCLUSION: We conclude that public health would benefit from: health institutions implementing formal knowledge management strategies; academic health sciences institutions incorporating formal digital literacy programs; and having health workers who are professionally responsible and functional in the information society.