Aplicación de las nuevas tecnologías en Atención Primaria en el control del paciente con sobrepeso u obesidad y factores de riesgo cardiovascular / Application of new technologies in Primary Care to monitor overweight or obese patients with cardiovascular risk factor

El objetivo es evaluar un seguimiento telemático (web o aplicación [app]) para pacientes con sobrepeso/obesidad y otros dos factores de riesgo cardiovascular: hipertensión arterial (HTA), dislipemia, diabetes mellitus (DM), sedentarismo, consumo tabáquico. Diseño: es un estudio de intervención con asignación aleatoria al grupo intervención (web o app) y al grupo control. Emplazamiento: centros de salud rurales y urbanos, docentes y no docentes, del Sector Zaragoza I. Participantes: 261 personas con índice de masa corporal (IMC) > 25 kg/m2 y otros dos factores de riesgo. Intervenciones: seguimiento de 18 meses con puntos de corte al inicio, 1, 6, 12 y 18 meses. Las mediciones principales son peso, tensión arterial, consumo tabáquico, eventos cardiovasculares, calidad de vida y bioquímica. Resultados: el grupo control finalizó el estudio en mayor proporción (79% versus 14%). El grupo control consiguió una pérdida del 8% de la mediana de peso al año y el grupo intervención un 5%. A los 6 meses, el grupo control logró disminuir el 7% la tensión arterial sistólica y el 5% la diastólica. La hemoglobina glicosilada (HbA1c) descendió un 1% en el grupo control y un 0,5% en el grupo intervención (test de Wilcoxon: 10; p = 0,089). El colesterol de lipoproteínas de baja densidad (cLDL) del grupo control descendió 9 mg/dL, y el del grupo intervención, 7 mg/dl (test de Wilcoxon: 1.089; p = 0,018). El hábito tabáquico disminuyó en todos los grupos (test de Wilcoxon: 21; p = 0,036). El grupo control presentó mayor prevalencia de eventos cardiovasculares. La calidad de vida mejoró en todos los grupos (test Wilcoxon: 979; p = 0,041). Conclusiones: las/los pacientes que acuden al centro de salud para un seguimiento de peso consiguen mejores resultados que si el seguimiento se hace de forma telemática.(AU)

The aim was to evaluate remote assistance (Web or App) for overweight/obese patients with two extra cardiovascular risk factors: hypertension, dyslipidemia, diabetes, smoking, sedentary lifestyle. Design: intervention study using random assignment for Web Group and App Group. The App Group was subsequently selected. Location: urban and rural health centres, teaching and non-teaching centres, in the Zaragoza I health area. Subjects: 261 people with BMI> 25 Kg/m2 and two extra cardiovascular risk factors. Interventions: 18 months follow up, initial checkups and after 1, 6, 12 and 18 months. The primary endpoints were: weight, blood pressure, tobacco consumption, cardiovascular events, quality of life and blood tests. Results: The control group completed the study in a higher proportion (79% vs 14%). The control and intervention groups attained a loss of 8% in and 5% median weight per year, respectively. After 6 months, the control group managed to reduce systolic and diastolic blood pressure by 7% and 5%, respectively. Glycosidic haemoglobin was 1% and 0.5% lower in the control and intervention groups, respectively (Wilcoxon Test=10; P= 0.089). Both groups reduced tobacco consumption (Wilcoxon=21; P=0.03). The control group had a higher prevalence of cardiovascular events. Quality of life improved (Wilcoxon Test=979; P=0.041). Conclusion: Patients visiting health centres to monitor weight obtain better results than those remotely assisted.(AU)

Tecnologia desenvolvida na Fiocruz será usada pelo MS contra o 'Aedes aegypti'

O Ministério da Saúde adotará as Estações Disseminadoras de Larvicida (EDLs), fruto de pesquisa desenvolvida pelo Instituto Leônidas & Maria Deane (ILMD/Fiocruz Amazônia), como diretriz da Coordenação-Geral de Vigilância de Arboviroses (CGARB/SVS/MS).

Aprendizaje automático aplicado en área de la salud: parte 2 / Machine Learning In Healthcare: part 2

En el artículo anterior se introdujo el tema y se desarrolló cómo es la recolección y análisis de datos, la selección y entrenamiento de modelos de aprendizaje automático supervisados y los métodos de validación interna que permiten corroborar si el modelo arroja resultados similares a los de otros conjuntos de entrenamiento y de prueba. En este artículo continuaremos con la descripción de la evaluación del rendimiento, la selección del modelo más adecuado para identificar la característica que se va a evaluar y la validación externa del modelo. Además, el artículo resume los desafíos existentes en la implementación del Machine Learning desde la investigación al uso clínico. (AU)

In the previous article, we introduced topics such as data collection and analysis, selection and training of supervised machine learning models and methods of internal validation that allow to corroborate whether the model yields similar results to other training and test sets.In this article, we will continue with the description of the performance evaluation, selecting the most appropriate model to identify the characteristic to evaluate and the external validation of the model. In addition, the article summarizes the actual challenges in the implementation of machine learning from research to clinical use. (AU)

The digital transformation of hepatology: The patient is logged in.

The rise in innovative digital health technologies has led a paradigm shift in health care toward personalized, patient-centric medicine that is reaching beyond traditional brick-and-mortar facilities into patients' homes and everyday lives. Digital solutions can monitor and detect early changes in physiological data, predict disease progression and health-related outcomes based on individual risk factors, and manage disease intervention with a range of accessible telemedicine and mobile health options. In this review, we discuss the unique transformation underway in the care of patients with liver disease, specifically examining the digital transformation of diagnostics, prediction and clinical decision-making, and management. Additionally, we discuss the general considerations needed to confirm validity and oversight of new technologies, usability and acceptability of digital solutions, and equity and inclusivity of vulnerable populations.

Digital Health Technologies for Remote Monitoring and Management of Inflammatory Bowel Disease: A Systematic Review.

INTRODUCTION: Digital health technologies may be useful tools in the management of chronic diseases. We performed a systematic review of digital health interventions in the management of patients with inflammatory bowel diseases (IBD) and evaluated its impact on (i) disease activity monitoring, (ii) treatment adherence, (iii) quality of life (QoL) measures, and/or (iv) health care utilization. METHODS: Through a systematic review of multiple databases through August 31, 2020, we identified randomized controlled trials in patients with IBD comparing digital health technologies vs standard of care (SoC) for clinical management and monitoring and reporting impact on IBD disease activity, treatment adherence, QoL, and/or health care utilization or cost-effectiveness. We performed critical qualitative synthesis of the evidence supporting digital health interventions in patients with IBD and rated certainty of evidence using Grading of Recommendations Assessment, Development and Evaluation. RESULTS: Overall, we included 14 randomized controlled trials (median, 98 patients; range 34-909 patients; follow-up <12 months) that compared web-based interventions, mobile applications, and different telemedicine platforms with SoC (clinic-based encounters). Although overall disease activity and risk of relapse were comparable between digital health technologies and SoC (very low certainty of evidence), digital health interventions were associated with lower rate of health care utilization and health care costs (low certainty of evidence). Digital health interventions did not significantly improve patients' QoL and treatment adherence compared with SoC (very low certainty of evidence). Trials may have intrinsic selection bias due to nature of digital interventions. DISCUSSION: Digital health technologies may be effective in decreasing health care utilization and costs, though may not offer advantage in reducing risk of relapse, QoL, and improving treatment adherence in patients with IBD. These techniques may offer value-based care for population health management.

Magnetic frequency mixing technological advances for the practical improvement of point-of-care testing.

Nanomaterials, especially superparamagnetic nanomaterials, have recently played essential roles in point-of-care testing due to their intrinsic magnetic, electrochemical, and optical properties. The inherent superparamagnetism of magnetic nanoparticles makes them highly sensitive for quantitative detection. Among the various magnetic detection technologies, frequency mixing technology (FMT) technology is an emerging detection technique in the nanomedical field. FMT sensors have high potential for development in the field of biomedical quantitative detection due to their simple structure, and they are not limited to the materials used. In particular, they can be applied for large-scale disease screening, early tumor marker detection, and low-dose drug detection. This review summarizes the principles of FMT and recent advances in the fields of immunoadsorption, lateral flow assay detection, magnetic imaging, and magnetic nanoparticles recognition. The advantages and limitations of FMT sensors for robust, ultrasensitive biosensing are highlighted. Finally, the future requirements and challenges in the development of this technology are described. This review provides further insights for researchers to inspire the future development of FMT by integration into biosensing and devices with a broad field of applications in analytical sensing and clinical usage.

Adoption of Advanced Microneurosurgical Technologies: An International Survey.

BACKGROUND: Operating microscopes and adjunctive technologies are continually refined to advance microneurosurgical care. How frequently these advances are used is unknown. In the present study, we assessed the international adoption of microneurosurgical technologies and discussed their value. METHODS: A 27-question electronic survey was distributed to cerebrovascular neurosurgeon members of U.S., European, and North American neurosurgical societies and social media networks of cerebrovascular and skull base neurosurgeons. The survey encompassed the surgeons' training background, surgical preferences, and standard microneurosurgical practices. RESULTS: Of the respondents, 56% (53 of 95) were attendings, 74% (70 of 95) were in their first 10 years of practice, and 67% (63 of 94) practiced at an academic teaching hospital. Vascular, endovascular, and skull base fellowships had been completed by 38% (36 of 95), 27% (26 of 95), and 32% (30 of 95) of the respondents, respectively. Most respondents did not use an exoscope (78%; 73 of 94), a mouthpiece (61%; 58 of 95), or foot pedals (56%; 55 of 94). All 95 respondents used a microscope, and 71 (75%) used Zeiss microscopes. Overall, 57 neurosurgeons (60%) used indocyanine green for aneurysms (n = 54), arteriovenous malformations (n = 43), and dural arteriovenous fistulas (n = 42). Most (80%; 75 of 94) did not use fluorescence. The respondents with a vascular-focused practice more commonly used indocyanine green, Yellow 560 fluorescence, and intraoperative 2-dimensional digital subtraction angiography. The respondents with a skull base-focused practice more commonly used foot pedals and an endoscope-assist device. CONCLUSIONS: The results from the present survey have characterized the current adoption of operative microscopes and adjunctive technologies in microneurosurgery. Despite numerous innovations to improve the symbiosis between neurosurgeon and microscope, their adoption has been underwhelming. Future advances are essential to improve surgical outcomes.

Evaluating the performance of drug-repurposing technologies.

Drug-repurposing technologies are growing in number and maturing. However, comparisons to each other and to reality are hindered because of a lack of consensus with respect to performance evaluation. Such comparability is necessary to determine scientific merit and to ensure that only meaningful predictions from repurposing technologies carry through to further validation and eventual patient use. Here, we review and compare performance evaluation measures for these technologies using version 2 of our shotgun repurposing Computational Analysis of Novel Drug Opportunities (CANDO) platform to illustrate their benefits, drawbacks, and limitations. Understanding and using different performance evaluation metrics ensures robust cross-platform comparability, enabling us to continue to strive toward optimal repurposing by decreasing the time and cost of drug discovery and development.

Artificial intelligence-enhanced drug design and development: Toward a computational precision medicine.

Artificial Intelligence (AI) relies upon a convergence of technologies with further synergies with life science technologies to capture the value of massive multi-modal data in the form of predictive models supporting decision-making. AI and machine learning (ML) enhance drug design and development by improving our understanding of disease heterogeneity, identifying dysregulated molecular pathways and therapeutic targets, designing and optimizing drug candidates, as well as evaluating in silico clinical efficacy. By providing an unprecedented level of knowledge on both patient specificities and drug candidate properties, AI is fostering the emergence of a computational precision medicine allowing the design of therapies or preventive measures tailored to the singularities of individual patients in terms of their physiology, disease features, and exposure to environmental risks.

LR-GNN: a graph neural network based on link representation for predicting molecular associations.

In biomedical networks, molecular associations are important to understand biological processes and functions. Many computational methods, such as link prediction methods based on graph neural networks (GNNs), have been successfully applied in discovering molecular relationships with biological significance. However, it remains a challenge to explore a method that relies on representation learning of links for accurately predicting molecular associations. In this paper, we present a novel GNN based on link representation (LR-GNN) to identify potential molecular associations. LR-GNN applies a graph convolutional network (GCN)-encoder to obtain node embedding. To represent associations between molecules, we design a propagation rule that captures the node embedding of each GCN-encoder layer to construct the LR. Furthermore, the LRs of all layers are fused in output by a designed layer-wise fusing rule, which enables LR-GNN to output more accurate results. Experiments on four biomedical network data, including lncRNA-disease association, miRNA-disease association, protein-protein interaction and drug-drug interaction, show that LR-GNN outperforms state-of-the-art methods and achieves robust performance. Case studies are also presented on two datasets to verify the ability to predict unknown associations. Finally, we validate the effectiveness of the LR by visualization.

Sexo, género y humanización de las tecnologías de cuidados para personas mayores / O sexo, o género e a humanização das tecnologias de cuidados aos idosos / Sex and gender and humanization of care technologies for the elderly

El envejecimiento de la población constituye en los países desarrollados uno de losprincipales desafíos para la salud pública. La innovación tecnológica emerge como una de las 187Cultura de los Cuidados. 3º Cuatrimestre 2021. Año XXV. nº 61respuestas recurrentes y esperanzadoras para abordar este fenómeno de forma sostenible. Serealiza una scoping review sobre el sexo y el género en tecnologías dedicadas a los cuidados quetienen características asimilables a la de los humanos, como la voz, los atributos físicos, lascompetencias sociales y culturales, etc. El resultado aporta veintinueve materiales, once abordanel envejecimiento y/o las relaciones de género en los asistentes de voz, mientras que 18 lo hacensobre tecnología robótica. La revisión crítica de la literatura científica nos permite determinar losprincipales rasgos que caracterizan a los dispositivos vinculándolos con un sexo determinado, yse analizan los dilemas que plantea la perpetuación de los estereotipos de género en relación conestas tecnologías. Por último, se destaca la necesidad de profundizar en las interacciones entrehumanos y tecnologías de los cuidados desde disciplinas como los Science, Tecnology and SocietyStudies o los estudios culturales, para abordar el diseño de tecnologías de asistencia dirigidas apersonas mayores, desde una perspectiva de género.(AU)

Population aging is one of the main challenges to public health in developed countries.Technological innovation is emerging as one of the recurrent and hopeful responses to addressthis phenomenon sustainably. A scoping review is conducted on sex and gender in caretechnologies that have characteristics assimilable to humans, such as voice, physical attributes,social and cultural competencies, etc. The result provides twenty-nine materials. Eleven addressaging and/or gender relations in voice assistants, while 18 address robotic technology. The criticalreview of the scientific literature allows us to determine the main features that characterize thedevices by linking them to a specific sex, and the dilemmas posed by the perpetuation of genderstereotypes concerning these technologies are analyzed. Finally, it highlights the need to deepenthe interactions between humans and care technologies from disciplines such as Science,Technology, and Society Studies or cultural studies, to address the design of assistive technologiesaimed at older people from a gender perspective.(AU)

O envelhecimento da população é um dos maiores desafios para a saúde pública nospaíses desenvolvidos. A inovação tecnológica está a emergir como uma das respostas recorrentese esperançosas para abordar este fenómeno de uma forma sustentável. É realizada uma revisão deâmbito sobre o género e o sexo nas tecnologias de cuidados que têm características semelhantesàs humanas, tais como voz, atributos físicos, competências sociais e culturais, etc. O resultadofornece vinte e nove materiais, onze dos quais abordam o envelhecimento e/ou as relações degénero nos assistentes de voz, enquanto 18 abordam a tecnologia robótica. A revisão crítica daliteratura científica permite-nos determinar as principais características que caracterizam osdispositivos, ligando-os a um sexo específico, e são analisados os dilemas colocados pelaperpetuação de estereótipos de género em relação a estas tecnologias. Finalmente, destaca anecessidade de aprofundar as interacções entre o ser humano e as tecnologias de cuidados desaúde de disciplinas como Ciência, Tecnologia e Estudos da Sociedade ou estudos culturais, paraabordar a concepção de tecnologias de assistência destinadas a pessoas idosas, a partir de umaperspectiva de género.(AU)

Mobile health technology for remote home monitoring after surgery: a meta-analysis.

BACKGROUND: Mobile health (mHealth) technology has been proposed as a method of improving post-discharge surveillance. Little is known about how mHealth has been used to track patients after surgery and whether its use is associated with differences in postoperative recovery. METHODS: Three databases (PubMed, MEDLINE and the Cochrane Central Registry of Controlled Trials) were searched to identify studies published between January 1999 and February 2021. Mobile health was defined as any smartphone or tablet computer capable of electronically capturing health-related patient information and transmitting these data to the clinical team. Comparable outcomes were pooled via meta-analysis with additional studies compiled via narrative review. The quality of each study was assessed based on Grading of Recommendations Assessment, Development, and Evaluation (GRADE) criteria. RESULTS: Forty-five articles met inclusion criteria. While the majority of devices were designed to capture general health information, others were specifically adapted to the expected outcomes or potential complications of the index procedure. Exposure to mHealth was associated with fewer emergency department visits (odds ratio 0.42, 95 per cent c.i. 0.23 to 0.79) and readmissions (odds ratio 0.47, 95 per cent c.i. 0.29 to 0.77) as well as accelerated improvements in quality of life after surgery. There were limited data on other postoperative outcomes. CONCLUSION: Remote home monitoring via mHealth is feasible, adaptable, and may even promote more effective postoperative care. Given the rapid expansion of mHealth, physicians and policymakers need to understand these technologies better so that they can be integrated into high-quality clinical care.

A systematic review was performed to determine how mobile health (mHealth) technology is being used to track surgical patients after hospital discharge, and whether exposure to mHealth is associated with differences in postoperative recovery. Remote home monitoring via mHealth is feasible and flexible enough to meet the demands of a variety of patients and clinical teams. Exposure to mHealth also appears to be associated with a reduction in both emergency department visits and hospital readmissions as well as accelerated improvements in quality of life. mHealth represents an important next step in postoperative surveillance, although better performance data, targeted incentives and clearer guidelines are still needed.

Neurodegeneration & imperfect ageing: Technological limitations and challenges?

Cellular homeostasis is regulated by the protein quality control (PQC) machinery, comprising multiple chaperones and enzymes. Studies suggest that the loss of the PQC mechanisms in neurons may lead to the formation of abnormal inclusions that may lead to neurological disorders and defective aging. The questions could be raised how protein aggregate formation precisely engenders multifactorial molecular pathomechanism in neuronal cells and affects different brain regions? Such questions await thorough investigation that may help us understand how aberrant proteinaceous bodies lead to neurodegeneration and imperfect aging. However, these studies face multiple technological challenges in utilizing available tools for detailed characterizations of the protein aggregates or amyloids and developing new techniques to understand the biology and pathology of proteopathies. The lack of detection and analysis methods has decelerated the pace of the research in amyloid biology. Here, we address the significance of aggregation and inclusion formation, followed by exploring the evolutionary contribution of these structures. We also provide a detailed overview of current state-of-the-art techniques and advances in studying amyloids in the diseased brain. A comprehensive understanding of the structural, pathological, and clinical characteristics of different types of aggregates (inclusions, fibrils, plaques, etc.) will aid in developing future therapies.

Digital health technology for non-motor symptoms in people with Parkinson's disease: Futile or future?

INTRODUCTION: There is an ongoing digital revolution in the field of Parkinson's disease (PD) for the objective measurement of motor aspects, to be used in clinical trials and possibly support therapeutic choices. The focus of remote technologies is now also slowly shifting towards the broad but more "hidden" spectrum of non-motor symptoms (NMS). METHODS: A narrative review of digital health technologies for measuring NMS in people with PD was conducted. These digital technologies were defined as assessment tools for NMS offered remotely in the form of a wearable, downloadable as a mobile app, or any other objective measurement of NMS in PD that did not require a hospital visit and could be performed remotely. Searches were performed using peer-reviewed literature indexed databases (MEDLINE, Embase, PsycINFO, Cochrane Database of Systematic Reviews, Cochrane CENTRAL Register of Controlled Trials), as well as Google and Google Scholar. RESULTS: Eighteen studies deploying digital health technology in PD were identified, for example for the measurement of sleep disorders, cognitive dysfunction and orthostatic hypotension. In addition, we describe promising developments in other conditions that could be translated for use in PD. CONCLUSION: Unlike motor symptoms, non-motor features of PD are difficult to measure directly using remote digital technologies. Nonetheless, it is currently possible to reliably measure several NMS and further digital technology developments are underway to offer further capture of often under-reported and under-recognised NMS.

Aptamer-Functionalized DNA-Silver Nanocluster Nanofilm for Visual Detection and Elimination of Bacteria.

As a new type of nanomaterial, DNA-templated silver nanoclusters (DNA-AgNCs) have been widely studied because of their fluorescence and antibacterial properties. In this study, we combined the DNA-AgNCs with aptamers of bacteria to achieve a novel approach for the visual detection and effective elimination of bacteria. The aptamers of Staphylococcus aureus (S. aureus) were linked to G-rich sequences to achieve fluorescence enhancement when approaching the DNA-AgNCs. The capture of aptamers not only realized the visual monitoring of bacteria but also promoted the antibacterial effects. Additionally, a fluorescent nanofilm with excellent selectivity and antibacterial activity in the detection and elimination of S. aureus was developed based on the DNA-AgNCs. These aptamer-functionalized DNA-AgNCs show significant potential for many applications in food packaging and biomedical engineering.

Recent Advances in Ionic Liquids in Biomedicine.

The use of ionic liquids and deep eutectic solvents in biomedical applications has grown dramatically in recent years due to their unique properties and their inherent tunability. This review will introduce ionic liquids and deep eutectics and discuss their biomedical applications, namely solubilization of drugs, creation of active pharmaceutical ingredients, delivery of pharmaceuticals through biological barriers, stabilization of proteins and other nucleic acids, antibacterial agents, and development of new biosensors. Current challenges and future outlooks are discussed, including biocompatibility, the potential impact of the presence of impurities, and the importance of understanding the microscopic interactions in ionic liquids in order to design task-specific solvents.

Weaving Enzymes with Polymeric Shells for Biomedical Applications.

Enzyme therapeutics have received increasing attention due to their high biological specificity, outstanding catalytic efficiency, and impressive therapeutic outcomes. Protecting and delivering enzymes into target cells while retaining enzyme catalytic efficiency is a big challenge. Wrapping of enzymes with rational designed polymer shells, rather than trapping them into large nanoparticles such as liposomes, have been widely explored because they can protect the folded state of the enzyme and make post-functionalization easier. In this review, the methods for wrapping up enzymes with protective polymer shells are mainly focused on. It is aimed to provide a toolbox for the rational design of polymeric enzymes by introducing methods for the preparation of polymeric enzymes including physical adsorption and chemical conjugation with specific examples of these conjugates/hybrid applications. Finally, a conclusion is drawn and key points are emphasized.

Making the COVID-19 Pandemic a Driver for Digital Health: Brazilian Strategies.

The COVID-19 outbreak exposed several problems faced by health systems worldwide, especially concerning the safe and rapid generation and sharing of health data. However, this pandemic scenario has also facilitated the rapid implementation and monitoring of technologies in the health field. In view of the occurrence of the public emergency caused by SARS-CoV-2 in Brazil, the Department of Informatics of the Brazilian Unified Health System created a contingency plan. In this paper, we aim to report the digital health strategies applied in Brazil and the first results obtained during the fight against COVID-19. Conecte SUS, a platform created to store all the health data of an individual throughout their life, is the center point of the Brazilian digital strategy. Access to the platform can be obtained through an app by the patient and the health professionals involved in the case. Health data sharing became possible due to the creation of the National Health Data Network (Rede Nacional de Dados em Saúde, RNDS). A mobile app was developed to guide citizens regarding the need to go to a health facility and to assist in disseminating official news about the virus. The mobile app can also alert the user if they have had contact with an infected person. The official numbers of cases and available hospital beds are updated and published daily on a website containing interactive graphs. These data are obtained due to creating a web-based notification system that uses the RNDS to share information about the cases. Preclinical care through telemedicine has become essential to prevent overload in health facilities. The exchange of experiences between medical teams from large centers and small hospitals was made possible using telehealth. Brazil took a giant step toward digital health adoption, creating and implementing important initiatives; however, these initiatives do not yet cover the entire health system. It is expected that the sharing of health data that are maintained and authorized by the patient will become a reality in the near future. The intention is to obtain better clinical outcomes, cost reduction, and faster and better services in the public health network.