Teledermatology Evaluation and Feedback Systems: A Tool for Improving Care.

Chile is a country where teledermatology has been growing exponentially since the implementation of a single national asynchronous teledermatology platform for the public system in December 2018. To ensure the quality of care in teledermatology systems, it is crucial to evaluate the fulfillment of basic specifiers such as ICD-Diagnosis, therapeutic suggestions, and diagnostic suggestions, among others. This article aims to evaluate the teledermatology system of the Chilean public health service by analyzing 243 randomly extracted consultations, representative of the 20,716 electronic consultations performed during 2020. Compliance with basic specifiers is evaluated. From these, fulfillment of core teledermatology functions, such as diagnostic and therapeutic suggestions, is observed in most consultations. There are statistically significant relationships between the patient's destination (primary health center [PHC] or face-to-face referral), pharmacological prescription, coverage of the drug prescribed by the public system, and the education received by the consulting physician. If the consultation is resolved in the PHC, there is a higher chance for pharmacological prescription, prescribing mostly drugs that are covered by the government. This is less likely to occur when patients are referred for face-to-face evaluation. A targeted evaluation of education, pharmacological prescriptions, and their applicability is key to improving the quality of teledermatology systems.

Impact of the COVID-19 Pandemic on Dermatology Care in the Chilean Public Health Sector.

Due to the Coronavirus-19 (COVID-19) pandemic, most resources of the public health system were allocated to the increasing demand from respiratory patients. From this, it is expected that specialty consultations would decrease drastically. Access to dermatology care in the Chilean public health has been historically limited. To evaluate the impact of the pandemic on dermatology care, the total number of dermatological consultations (DCs) to the Chilean public sector in 2020 is analyzed according to sex and age range and compared with the available databases from 2017 to 2019. From this, 120,095 DCs were performed during 2020, with an incidence of 6.3 consultations per 1000 inhabitants. When compared to 2019 (n = 250,649), there was a 52.1% decrease. The regions most affected were located in the central part of Chile, which correlates with the regions most affected by the pandemic. Age and sex distributions remained similar to previous years but lower in amplitude. The month with the lowest number of consultations was April, with a gradual increase observed thereafter until December 2020. Although DCs decreased drastically in the Chilean public sector during 2020, sex and age range proportions were conserved, thus affecting all groups in a similar manner.

Dynamic quarantine: a comparative analysis of the Chilean public health response to COVID-19.

In this study, an analysis of the Chilean public health response to mitigate the spread of COVID-19 is presented. The analysis is based on the daily transmission rate (DTR). The Chilean response has been based on dynamic quarantines, which are established, lifted or prolonged based on the percentage of infected individuals in the fundamental administrative sections, called communes. This analysis is performed at a national level, at the level of the Metropolitan Region (MR) and at the commune level in the MR according to whether the commune did or did not enter quarantine between late March and mid-May of 2020. The analysis shows a certain degree of efficacy in controlling the pandemic using the dynamic quarantine strategy. However, it also shows that apparent control has only been partially achieved to date. With this policy, the control of the DTR partially falls to 4%, where it settles, and the MR is the primary vector of infection at the country level. For this reason, we can conclude that the MR has not managed to control the disease, with variable results within its own territory.

Lateral Prefrontal Theta Oscillations Reflect Proactive Cognitive Control Impairment in Males With Attention Deficit Hyperactivity Disorder.

Attention Deficit Hyperactivity Disorder (ADHD) is a common neuropsychiatric disorder in which children present prefrontal cortex (PFC) related functions deficit. Proactive cognitive control is a process that anticipates the requirement of cognitive control and crucially depends on the maturity of the PFC. Since this process is important to ADHD symptomatology, we here test the hypothesis that children with ADHD have proactive cognitive control impairments and that these impairments are reflected in the PFC oscillatory activity. We recorded EEG signals from 29 male children with ADHD and 25 typically developing (TD) male children while they performed a Go-Nogo task, where the likelihood of a Nogo stimulus increased while a sequence of consecutive Go stimuli elapsed. TD children showed proactive cognitive control by increasing their reaction time (RT) concerning the number of preceding Go stimuli, whereas children with ADHD did not. This adaptation was related to modulations in both P3a potential and lateral prefrontal theta oscillation for TD children. Children with ADHD as a group did not demonstrate either P3a or theta modulation. But, individual variation in theta activity was correlated with the ADHD symptomatology. The results depict a neurobiological mechanism of proactive cognitive control impairments in children with ADHD.

Mental health and the COVID-19 pandemic in Chile.

With one of the highest testing rates of COVID-19 in Latin America, Chile continues to record low mortality rates from the disease. Several measures such as curfews, cancellation of large gatherings, and closure of schools and businesses have been implemented. Against the backdrop of high levels of alcohol/substance abuse, mental health disorders, and inequalities across Chile, it is likely that levels of stress and anxiety will peak during the COVID-19 pandemic. As key public health responses such as testing, contact tracing, isolation and management of confirmed cases of COVID-19 are being ramped up, it is expedient to prioritize measures to safeguard the mental health of Chileans. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Optimization of group size in pool testing strategy for SARS-CoV-2: A simple mathematical model.

Coronavirus disease (Covid-19) has reached unprecedented pandemic levels and is affecting almost every country in the world. Ramping up the testing capacity of a country supposes an essential public health response to this new outbreak. A pool testing strategy where multiple samples are tested in a single reverse transcriptase-polymerase chain reaction (RT-PCR) kit could potentially increase a country's testing capacity. The aim of this study is to propose a simple mathematical model to estimate the optimum number of pooled samples according to the relative prevalence of positive tests in a particular healthcare context, assuming that if a group tests negative, no further testing is done whereas if a group tests positive, all the subjects of the group are retested individually. The model predicts group sizes that range from 11 to 3 subjects. For a prevalence of 10% of positive tests, 40.6% of tests can be saved using testing groups of four subjects. For a 20% prevalence, 17.9% of tests can be saved using groups of three subjects. For higher prevalences, the strategy flattens and loses effectiveness. Pool testing individuals for severe acute respiratory syndrome coronavirus 2 is a valuable strategy that could considerably boost a country's testing capacity. However, further studies are needed to address how large these groups can be, without losing sensitivity on the RT-PCR. The strategy best works in settings with a low prevalence of positive tests. It is best implemented in subgroups with low clinical suspicion. The model can be adapted to specific prevalences, generating a tailored to the context implementation of the pool testing strategy.

Modelling pool testing for SARS-CoV-2: addressing heterogeneity in populations.

Amplifying the testing capacity and making better use of testing resources is a crucial measure when fighting any pandemic. A pooled testing strategy for SARS-CoV-2 has theoretically been shown to increase the testing capacity of a country, especially when applied in low prevalence settings. Experimental studies have shown that the sensitivity of reverse transcription-polymerase chain reaction is not affected when implemented in small groups. Previous models estimated the optimum group size as a function of the historical prevalence; however, this implies a homogeneous distribution of the disease within the population. This study aimed to explore whether separating individuals by age groups when pooling samples results in any further savings on test kits or affects the optimum group size estimation compared to Dorfman's pooling, based on historical prevalence. For this evaluation, age groups of interest were defined as 0-19 years, 20-59 years and over 60 years old. Generalisation of Dorfman's pooling was performed by adding statistical weight to the age groups based on the number of confirmed cases and tests performed in the segment. The findings showed that when the pooling samples are based on age groups, there is a decrease in the number of tests per subject needed to diagnose one subject. Although this decrease is minuscule, it might account for considerable savings when applied on a large scale. In addition, the savings are considerably higher in settings where there is a high standard deviation among the positivity rate of the age segments of the general population.

Consultas a dermatología en el sector público de salud en Chile en 2019 / Consultations to dermatology in the public sector of health in Chile in 2019

Introducción: Existe una amplia heterogeneidad en la distribución de médicos y especialistas en las distintas regiones de Chile. Dermatología no está exenta de esta realidad. Conocer la población consultante resulta clave para complementar la situación sanitaria que la distribución de médicos y diferencias en el acceso, reflejan a nivel nacional. Objetivo: Analizar descriptivamente las consultas a Dermatología durante el 2019 en el Sector Público de salud en Chile; según región, rango etario y consultas en operativos. Materiales y Métodos: 250.649 consultas realizadas a Dermatología reportadas por el DEIS durante el 2019. Resultados: Del total de las consultas a cualquier especialidad en el sector público de salud, las consultas a Dermatología suponen un 2.7%. De estas, la Región Metropolitana concentra el 45.2% mientras que la Región de Aysén es la que más consulta en función de su población. Se establece un promedio nacional de 14.1 consultas por cada 1000 habitantes. Las Zonas Norte y Centro consultan bajo este promedio, mientras que la Zona Sur consulta por sobre este. En cuanto al rango etario, se establecen peaks de consultas entre los 0-4 años, 15-19 y finalmente 75-79. Discusión: Dermatología presenta un porcentaje no despreciable del total de consultas a especialidad. Destaca la baja consulta en la Zona Norte, dado el antecedente de mayor prevalencia de cáncer de piel no melanoma respecto a la media nacional. Asimismo, la mayor consulta en Aysén se condice con una mayor densidad de médicos en la región, respecto a otras regiones.

Introduction: There is wide heterogeneity in the distribution of physicians in the different regions of Chile. Dermatology is no different from this reality. Studying the consulting population is key to complement the health situation that the distribution of physicians and differences in healthcare access reflect at the national level. Objective: To perform a descriptive analysis of the consultations made to Dermatology during 2019 in the Chilean Public Health Sector; according to region, age-range, and consultations in Health operatives. Materials and Methods: 250,649 consultations to Dermatology reported by the DEIS during 2019. Reslts: Of the total number of consultations to any specialty on the public sector, Dermatology accounts for 2.7%. Of these, the Metropolitan Region concentrates 45.2% of the consultations. Aysén is the region with the most consultations according to its population. There is a national average of 14.1 consultations per 1000 inhabitants. The Northern and Central regions consult below this average, while the Southern regions consult above it. Regarding age range, peaks of consultations are established between 0-4 years, 15-19 and finally 75-79. Discussion: Dermatology accounts for a non-negligible percentage of the total number of consultations to specialty. The low number of consultations in the Northern Zone is remarkable, given the history of high UV radiation in the area. Likewise, the greater number of consultations in Aysén is consistent with a greater density of physicians in the region when compared to other regions.