Acceptability of HPV Vaccines: A Qualitative Systematic Review and Meta-Summary.

In 2006, the human papillomavirus (HPV) vaccine was approved for use as an effective intervention for reducing the risk of developing cervical cancer; however, its successful implementation is dependent on acceptability. This study aims to provide a comprehensive understanding of the reasons that favor or do not favor the acceptability of HPV vaccines. METHODS: We conducted a systematic review and meta-summary of qualitative research on 16 databases. A total of 32 articles that considered the perspectives of vaccine users, their parents, and the professionals who care for them were reviewed. Synthesis was conducted as described by Sandelowski and Barroso. RESULTS: We used inductive and deductive methods to obtain a total of 22 dimensions, out of which three issues stood out that should be considered to improve acceptability and are formed by three groups of study, namely, information about the vaccine, fears and side effects, and sexuality associated with the vaccine. CONCLUSIONS: Acceptability, as well as adherence to HPV vaccination, is a complex concept. This review highlights the perspectives of the three sets of actors involved in the process (i.e., users, parents, and professionals) and views these factors in relation to acceptability as a guide for new interventions.

Predicting Cardiovascular Rehabilitation of Patients with Coronary Artery Disease Using Transfer Feature Learning.

Cardiovascular diseases represent the leading cause of death worldwide. Thus, cardiovascular rehabilitation programs are crucial to mitigate the deaths caused by this condition each year, mainly in patients with coronary artery disease. COVID-19 was not only a challenge in this area but also an opportunity to open remote or hybrid versions of these programs, potentially reducing the number of patients who leave rehabilitation programs due to geographical/time barriers. This paper presents a method for building a cardiovascular rehabilitation prediction model using retrospective and prospective data with different features using stacked machine learning, transfer feature learning, and the joint distribution adaptation tool to address this problem. We illustrate the method over a Chilean rehabilitation center, where the prediction performance results obtained for 10-fold cross-validation achieved error levels with an NMSE of 0.03±0.013 and an R2 of 63±19%, where the best-achieved performance was an error level with a normalized mean squared error of 0.008 and an R2 up to 92%. The results are encouraging for remote cardiovascular rehabilitation programs because these models could support the prioritization of remote patients needing more help to succeed in the current rehabilitation phase.

Femicide and Attempted Femicide before and during the COVID-19 Pandemic in Chile.

Experts and international organizations hypothesize that the number of cases of fatal intimate partner violence against women increased during the COVID-19 pandemic, primarily due to social distancing strategies and the implementation of lockdowns to reduce the spread of the virus. We described cases of attempted femicide and femicide in Chile before (January 2014 to February 2020) and during (March 2020 to June 2021) the pandemic. The attempted-femicide rate increased during the pandemic (incidence rate ratio: 1.22 [95% confidence interval: 1.04 to 1.43], p value: 0.016), while the rate of femicide cases remained unchanged. When a comparison between attempted-femicide and femicide cases was performed, being a foreigner, having an intimate partner relationship with a perpetrator aged 40 years or more, and the use of firearms during the assault were identified as factors associated independently with a higher probability of being a fatal victim in Chile. In conclusion, this study emphasizes that attempted femicide and femicide continued to occur frequently in family contexts both before and during the COVID-19 pandemic.

Active revegetation after mining: what is the contribution of peer-reviewed studies?

Knowing the state of the art on research related to post-mining active revegetation can help to improve revegetation success and identify research gaps. We performed a systematic review about active revegetation after mining and identified 203 relevant studies. Most studies were performed in the USA (34%), in regions with a temperate climate (59%) and in abandoned coal mines (45%). The studies were focused on the plantation of woody species (59%) or sowing of herbaceous species (39%). The most widely evaluated treatments were the addition of amendments (24%) and fertilizers (21%), mainly with positive and neutral effects; in general, organic amendments presented more positive effects than inorganic amendments and fertilizers. We also identified studies on the effects of plowing, inoculation of microorganisms, nurse plants, herbivore exclusion and watering. The results of these treatments should be taken with caution, because they can vary according to the functional strategies of the introduced species and the local context, such as the degree of nutrient limitation in the mining area and abiotic conditions. Further research is needed in non-temperate climates, involving long-term monitoring and with detailed descriptions of the interventions to better interpret results and general implications of active revegetation of mining areas.

Impact of Remote Monitoring Technologies for Assisting Patients With Gestational Diabetes Mellitus: A Systematic Review.

Introduction: In Chile, 1 in 8 pregnant women of middle socioeconomic level has gestational diabetes mellitus (GDM), and in general, 5-10% of women with GDM develop type 2 diabetes after giving birth. Recently, various technological tools have emerged to assist patients with GDM to meet glycemic goals and facilitate constant glucose monitoring, making these tasks more straightforward and comfortable. Objective: To evaluate the impact of remote monitoring technologies in assisting patients with GDM to achieve glycemic goals, and know the respective advantages and disadvantages when it comes to reducing risk during pregnancy, both for the mother and her child. Methods: A total of 188 articles were obtained with the keywords "gestational diabetes mellitus," "GDM," "gestational diabetes," added to the evaluation levels associated with "glucose level," "glycemia," "glycemic index," "blood sugar," and the technological proposal to evaluate with "glucometerm" "mobile application," "mobile applications," "technological tools," "telemedicine," "technovigilance," "wearable" published during the period 2016-2021, excluding postpartum studies, from three scientific databases: PUBMED, Scopus and Web of Science. These were managed in the Mendeley platform and classified using the PRISMA method. Results: A total of 28 articles were selected after elimination according to inclusion and exclusion criteria. The main measurement was glycemia and 4 medical devices were found (glucometer: conventional, with an infrared port, with Bluetooth, Smart type and continuous glucose monitor), which together with digital technology allow specific functions through 2 identified digital platforms (mobile applications and online systems). In four articles, the postprandial glucose was lower in the Tele-GDM groups than in the control group. Benefits such as improved glycemic control, increased satisfaction and acceptability, maternal confidence, decreased gestational weight gain, knowledge of GDM, and other relevant aspects were observed. There were also positive comments regarding the optimization of the medical team's time. Conclusion: The present review offers the opportunity to know about the respective advantages and disadvantages of remote monitoring technologies when it comes to reducing risk during pregnancy. GDM centered technology may help to evaluate outcomes and tailor personalized solutions to contribute to women's health. More studies are needed to know the impact on a healthcare system.

An Efficient Multi-Level Convolutional Neural Network Approach for White Blood Cells Classification.

The evaluation of white blood cells is essential to assess the quality of the human immune system; however, the assessment of the blood smear depends on the pathologist's expertise. Most machine learning tools make a one-level classification for white blood cell classification. This work presents a two-stage hybrid multi-level scheme that efficiently classifies four cell groups: lymphocytes and monocytes (mononuclear) and segmented neutrophils and eosinophils (polymorphonuclear). At the first level, a Faster R-CNN network is applied for the identification of the region of interest of white blood cells, together with the separation of mononuclear cells from polymorphonuclear cells. Once separated, two parallel convolutional neural networks with the MobileNet structure are used to recognize the subclasses in the second level. The results obtained using Monte Carlo cross-validation show that the proposed model has a performance metric of around 98.4% (accuracy, recall, precision, and F1-score). The proposed model represents a good alternative for computer-aided diagnosis (CAD) tools for supporting the pathologist in the clinical laboratory in assessing white blood cells from blood smear images.

Air quality assessment and pollution forecasting using artificial neural networks in Metropolitan Lima-Peru.

The prediction of air pollution is of great importance in highly populated areas because it directly impacts both the management of the city's economic activity and the health of its inhabitants. This work evaluates and predicts the Spatio-temporal behavior of air quality in Metropolitan Lima, Peru, using artificial neural networks. The conventional feedforward backpropagation known as Multilayer Perceptron (MLP) and the Recurrent Artificial Neural network known as Long Short-Term Memory networks (LSTM) were implemented for the hourly prediction of [Formula: see text] based on the past values of this pollutant and three meteorological variables obtained from five monitoring stations. The models were validated using two schemes: The Hold-Out and the Blocked-Nested Cross-Validation (BNCV). The simulation results show that periods of moderate [Formula: see text] concentration are predicted with high precision. Whereas, for periods of high contamination, the performance of both models, the MLP and LSTM, were diminished. On the other hand, the prediction performance improved slightly when the models were trained and validated with the BNCV scheme. The simulation results showed that the models obtained a good performance for the CDM, CRB, and SMP monitoring stations, characterized by a moderate to low level of contamination. However, the results show the difficulty of predicting this contaminant in those stations that present critical contamination episodes, such as ATE and HCH. In conclusion, the LSTM recurrent artificial neural networks with BNCV adapt more precisely to critical pollution episodes and have better predictability performance for this type of environmental data.

Evaluating Clinical Outcomes for Determining the Optimal Delay to Skin Incision under WALANT: A Prospective Series of 34 Patients from a Low-Resource Tertiary Setting.

BACKGROUND: Additional studies on clinical outcomes to determine the optimal time delay from injection of local anesthesia to skin incision for WALANT surgeries are needed. The authors aimed to propose the optimal time delay from local injection to skin incision for WALANT surgeries of the hand and wrist by analyzing intraoperative blood loss, postoperative pain scores, and complication rates. METHODS: Thirty-four patients were consecutively recruited and allocated by either 7-min or 30-min delay for skin incision from local injection of epinephrine with lidocaine. Intraoperative bleeding and postoperative pain scores were analyzed between both groups by Mann-Whitney U-test, while complication rates were compared using Fisher's exact test. RESULTS: The present study did not find significant differences in mean intraoperative blood loss (8 ± 5.8 mL vs. 5 ± 2.2 mL, p=0.074), complication rates (18% vs. 0%, p=0.227), and mean pain scores (1.2 ± 0.5 vs. 1.4 ± 0.5, p=0.307) between the 7-min and 30-min groups. CONCLUSION: The authors conclude that a waiting time of 7 min from the injection of local anesthesia is sufficient to achieve comparable clinical outcomes for minor hand and wrist surgeries under WALANT.

Percepción de enfermería respecto a la atención hospitalaria otorgada a personas que viven con VIH / Percepção da enfermagem em relação a atenção hospitalar dada para pessoas que vivem com HIV / Nursing perception regarding the attention given in hospitals to patients that live with HIV

Resumen: Dado el contexto epidemiológico en Chile referente al alza de la cantidad de personas con VIH, cobra relevancia el fortalecimiento del cuidado otorgado a estos pacientes. Por esto, el objetivo de esta investigación es conocer la percepción de enfermeras(os) respecto a la atención otorgada a personas que viven con VIH (PVVIH) en un servicio hospitalario de atención terciaria de salud, buscando contribuir a la enfermería. Para ello se utilizó un paradigma de investigación cualitativo tipo estudio de caso, recolectando la información con una entrevista semiestructurada, finalizando con un análisis del discurso de tipo semiótico. Se destacó que en las primeras atenciones se generaba "temor" en la atención a PVVIH, el que desaparecía a medida que aumentaban los conocimientos de la profesional. Enfermeras participantes refirieron la inexistencia de diferencias en la atención entre PVVIH y otros pacientes, evidenciándose una incongruencia entre el discurso y el actuar en enfermería al ocupar mayores medidas de precaución al realizar procedimientos a PVVIH. Como fortalezas identificadas en la atención a PVVIH se encontró el no discriminar a pacientes, la capacidad de enfrentar distintos contextos de atención y la destreza procedimental, entre otras, mientras que los aspectos a mejorar en la atención se vincularon con la relación que se genera con los PVVIH y sus familiares. Como conclusión, las enfermeras no hacen mayores distinciones en la atención con PVVIH. Es importante que las profesionales reconozcan sus habilidades y aspectos a mejorar para seguir humanizando la atención a PVVIH, siendo agentes educadores y de cambio.

Resumo: Dado o contexto epidemiológico no Chile referente ao aumento das pessoas com HIV, é relevante a necessidade de fortalecer os cuidados desses pacientes. Devido a isso, o objetivo de esta pesquisa é conhecer a percepção de enfermeiros(as) em relação a atenção fornecida para as pessoas que vivem com HIV num serviço hospitalar de atenção terciária em saúde, buscando contribuir para a disciplina e profissão de enfermagem. Para isso se utilizou um paradigma de pesquisa qualitativo tipo estudo de caso, o meio para reunir informação foi a entrevista semiestruturada, finalizando com uma análise de discurso. Destacou que nas primeiras atenções de pessoas portadoras de HIV o "temor" era perceptível. "Temor" que desaparecia à medida que o conhecimento do profissional aumentava. Enfermeiros participantes falaram que não existe diferença alguma na forma de atenção de pacientes portadores de HIV, mas se notou uma incongruência entre o discurso e a atuação da enfermagem ao tomar maiores medidas de precaução no momento de realizar procedimentos com esses pacientes. Pontos fortes identificados na atenção de portadores de HIV foram a não discriminação dos pacientes, a capacidade de enfrentar-se a distintos contextos na atenção, as habilidades de procedimentos, entre outras. Enquanto aos aspectos a melhorar na atenção se vincularam com a relação que se gera como os pacientes portadores de HIV e seus familiares Como conclusão os enfermeiros( não fazem maiores distinções na atenção de pacientes com HIV. É importante que os profissionais reconheçam suas habilidades e pontos para melhorar e assim continuar avançando na humanização da atenção dos portadores de HIV conseguindo ser agentes educadores e de mudança.

Abstract: Given the epidemiological context in Chile concerning the increased quantities of people with HIV, improving the care given to these patients becomes relevant. The objective of this research is to find about the perception of nurses concerning the care given to people living with HIV (PLHIV) in a tertiary health care hospital service, seeking to contribute to nursing improvements. In order to accomplish this task a qualitative research paradigm was used as a type of case study, collecting the information with a semi-structured interview, ending with a semiotic analysis of the discourse. It was pointed out that in the first sessions there is some fear generated in the attention to PLHIV, which gradually disappears with the increase of the professional's knowledge. Participating nurses referred to the lack of differences in care between PLHIV and other patients, evidencing an incongruence between the speech and the action by taking greater precautions when performing procedures for PLHIV. The strengths identified in the attention to PLHIV were the no discrimination to these patients, the ability to face different contexts of attention and the procedural skills, among others, while aspects to improvement in care were linked to the relationship that is generated with PLHIV and their families. In conclusion, nurses do not make noticeable distinctions in the care of PLVIH. It is important that professionals recognize their skills and the aspects that can be improved in order to continue humanizing the attention to PLHIV, acting as educators and agents of change.

El sangrado menstrual excesivo afecta la calidad de vida en adolescentes / Heavy menstrual bleeding affects quality of life in adolescents

Resumen Introducción: El sangrado menstrual excesivo (SME) se presenta aproximadamente en 37% de las adolescentes y afecta en distinto grado su calidad de vida. Objetivo: Medir la magnitud del impacto del SME en la calidad de vida en adolescentes. Pacientes y Método: Se entrevistó a adolescentes con diagnóstico de SME entre 10 y 18 años y a uno de sus tutores. Se aplicó el cuestionario de calidad de vida PedsQL 4.0 escala genérica, su versión Proxy PedsQL 4.0 al tutor, más 3 preguntas sobre limitación de actividades diarias. La concordancia entre la percepción de calidad de vida del tutor y adolescente se evaluó con el gráfico de Bland y Altman. Resultados: 46 adolescentes y tutores fueron evaluados. El puntaje total promedio PedsQL 4.0 para las adolescentes fue 64,48 (DS 14,54), con un rango de 18,48 a 88,04 con mayor compromiso en la dimensión emocional. Un 50% de las adoles centes falta al colegio, 80,4% a educación física y 65,2% a actividades al aire libre o fiestas. No hubo concordancia entre la percepción de las adolescentes y sus tutores. Conclusiones: Se evidenció un deterioro de la calidad de vida de las adolescentes encuestadas, siendo la dimensión emocional la más afectada. El desempeño en el cuestionario fue incluso más bajo que en patologías crónicas publicadas con esta misma herramienta.

Abstract Introduction: Heavy menstrual bleeding (HMB) occurs in 37% of adolescents and compromise their quality of life. Objective: To measure the magnitude of the impact of the SME on the quality of life in adolescents. Patients and Method: We interviewed adolescents diagnosed with HMB between 10 and 18 years old and one of their guardians. PedsQL 4.0 generic core scale was applied to measure quality of life, its Proxy PedsQL 4.0 version was applied to the guardian and 3 more questions to adolescents about limitation of daily activities. The concordance between the guardian's perception of the adolescent quality of life and the adolescent's perception was evaluated with the Bland and Altman graph. Results: 46 adolescents and guardians were evaluated. The total average PedsQL 4.0 score for adolescents was 64.48 (SD 14.54), with a range of 18.48 to 88.04 with a greater involvement in the emotional dimension. 50% of adolescents missed school, 80.4% physical education and 65.2% outdoor activities or parties. There was no agreement between the perception of the girls and guar dians. Conclusions: We evidence a deterioration in the quality of life of the surveyed adolescents, being the emotional dimension most affected. The performance in the questionnaire was also lower than in samples of chronic diseases published with this same tool.

[Heavy menstrual bleeding affects quality of life in adolescents]. / El sangrado menstrual excesivo afecta la calidad de vida en adolescentes.

INTRODUCTION: Heavy menstrual bleeding (HMB) occurs in 37% of adolescents and compromise their quality of life. OBJECTIVE: To measure the magnitude of the impact of the SME on the quality of life in adolescents. PATIENTS AND METHOD: We interviewed adolescents diagnosed with HMB between 10 and 18 years old and one of their guardians. PedsQL 4.0 generic core scale was applied to measure quality of life, its Proxy PedsQL 4.0 version was applied to the guardian and 3 more questions to adolescents about limitation of daily activities. The concordance between the guardian's perception of the adolescent quality of life and the adolescent's perception was evaluated with the Bland and Altman graph. RESULTS: 46 adolescents and guardians were evaluated. The total average PedsQL 4.0 score for adolescents was 64.48 (SD 14.54), with a range of 18.48 to 88.04 with a greater involvement in the emotional dimension. 50% of adolescents missed school, 80.4% physical education and 65.2% outdoor activities or parties. There was no agreement between the perception of the girls and guar dians. CONCLUSIONS: We evidence a deterioration in the quality of life of the surveyed adolescents, being the emotional dimension most affected. The performance in the questionnaire was also lower than in samples of chronic diseases published with this same tool.

Do Wildfires Promote Woody Species Invasion in a Fire-Adapted Ecosystem? Post-fire Resprouting of Native and Non-native Woody Plants in Central Argentina.

We asked whether prescribed fire could be a useful management tool to reduce invasion by non-native plants in an ecosystem where native plants are supposed to be adapted to fires. Specifically, we compare the post-fire resprouting response of native and non-native woody species in Chaco Serrano forest of central Argentina. The measurements were carried out in five burnt areas where we selected ten native and seven non-native species. Our response variables were (1) post-fire survival, (2) types of resprouts, and (3) the growth of the resprouts. Our main results show that one year after the fire, survivals of native and non-native species were 0.84 and 0.89, respectively, with variances in survival seven times smaller in the native species group. Type of resprout was also less variable in native species, while growth of the resprouts was similar in native and non-native groups. We interpret that in most cases, the burning a forest with mixed native and non-native plants through prescribed fires will not differentially stop the invasion by non-native woody species even in ecosystems which are presumed to be relatively resistant to fires such as our study area.

Erradicación de Helicobacter pylori para la trombocitopenia inmune: protocolo de una revisión sistemática / Eradication of Helicobacter pylori for immune thrombocytopenia: protocol of a systematic review

Introducción: La trombocitopenia inmune es una enfermedad caracterizada por destrucción plaquetaria mediada por anticuerpos. Se ha planteado que Helicobacter pylori podría actuar como gatillante y modulador de dicha enfermedad, por lo que el objetivo de esta revisión es evaluar si la erradicación de este agente podría constituir un tratamiento efectivo para la trombocitopenia inmune. Métodos: El protocolo fue diseñado, y será reportado, en línea con Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P). Se realizará una búsqueda de estudios controlados aleatorizados, que incluyan pacientes con trombocitopenia inmune y que hayan recibido terapia de erradicación para Helicobacter pylori. Los desenlaces a evaluar serán el sangrado, la mortalidad, la necesidad de esplenectomía, el incremento en el recuento plaquetario, entre otros. Realizaremos búsquedas sensibles en MEDLINE, CENTRAL y EMBASE, sin restricción por lenguaje o publicación, las cuales serán complementadas con búsquedas en otras fuentes. Al menos dos investigadores realizarán de manera independiente la selección de los estudios y la extracción de los datos. Se evaluará el riesgo de sesgo utilizando la herramienta recomendada por la colaboración Cochrane. Se realizará metanálisis y se presentarán los datos mediante el método GRADE. Fortalezas y debilidades: Esta revisión sistemática entregará una síntesis rigurosa y actualizada de los efectos de la erradicación de Helicobacter pylori en la trombocitopenia inmune. La principal limitación podría provenir de la baja revisión sistemática (PROSPERO): CRD42015022161.(AU)

Background: Immune Thrombocytopenia is a condition characterized by antibody-mediated platelet destruction. Helicobacter pylori has been postulated as a potential trigger or modulator in this disease, so Helicobacter pylori eradication has been proposed as a reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P). We will conduct a search of randomized controlled trials, including patients with immune thrombocytopenia that received eradication therapy for Helicobacter pylori. The evaluated outcomes will be bleeding, mortality, need of splenectomy, platelet count, among others. We will develop sensitive search strategies for MEDLINE, EMBASE and CENTRAL, with no language or publication restriction. We will complement electronic searches with other sources. At least two reviewers will independently select trials and extract data. We will use Cochrane tool for risk of bias assessment to assess included studies. We will conduct meta-analysis and data will be presented using the GRADE approach. Strengths and limitations: This systematic review will provide a rigorous and updated summary of the effects of Helicobacter pylori eradication on immune thrombocytopenia. The main limitation might arise from the low quantity or quality of trials identified for this topic. Systematic review register number (PROSPERO): CRD42015022161(AU)

[Alcohol consumption among traveling Chilean older people]. / Consumo de alcohol en el adulto mayor chileno que viaja.

BACKGROUND: Problems associated with alcohol consumption are prevalent in Chile, but little is known about the situation in the elderly. AIM: To perform a screening to detect alcohol-related problems and risks in the Chilean older people who travel. MATERIAL AND METHODS: The Alcohol Use Disorders Identification Test (AUDIT) questionnaire was answered by 1,076 travelers aged 60 to 93 years (66% females), who participated in trips organized by the Chilean National Tourism Service (SERNATUR). RESULTS: Seventy six percent of respondents acknowledged to have ingested an alcoholic drink during the last month. The average AUDIT score was of 2.2 ± 2.6. Only 3.7% of the sample had a score equal or higher than eight, considered as risky use. Within this last group, 60% had symptoms of alcohol dependence. A higher alcohol consumption was associated with male gender (p < 0.01), being younger than 75 years of age (p < 0.01), having a medium-low economic income (p < 0.01) and having a higher education level (p = 0.03). There was no significant association with the respondents' occupation. CONCLUSIONS: In this sample of Chilean traveling older people, there was a high prevalence of alcohol consumption, and nearly 4% of respondents had alcohol related problems.