A new class of patient-driven health care services is emerging to supplement and extend traditional health care delivery models and empower patient self-care. Patient-driven health care can be characterized as having an increased level of information flow, transparency, customization, collaboration and patient choice and responsibility-taking, as well as quantitative, predictive and preventive aspects. The potential exists to both improve traditional health care systems and expand the concept of health care though new services. This paper examines three categories of novel health services: health social networks, consumer personalized medicine and quantified self-tracking.
The relevance of humanitarian analysis of digitization of medicine is conditioned by the fact that digitization track is a general component of transformation of entire health care system, including relationships between subjects of medicine, changes in content of professional competencies of physician. The necessity of discussion and multilateral reflection of digitization processes unites developers, physicians, management staff of industry, representatives of social and humanitarian sciences.
Patrícia Rodrigues Dias de Souza, Patrícia Henriques, Ana Lúcia de Magalhães Fittipaldi
O objetivo do estudo foi conhecer as percepções de puérperas sobre aspectos do período gestacional relacionados à alimentação, ao aleitamento materno e às orientações nutricionais recebidas, por meio de uma pesquisa qualitativa. Como técnica de pesquisa, utilizaram-se entrevistas semiestruturadas analisadas segundo a análise de conteúdo e interpretadas pelo referencial teórico da hermenêutica-dialética. Foram identificadas três categorias de análise, como orientações sobre alimentação e aleitamento materno no pré-natal; hábitos alimentares maternos e a importância da alimentação para a saúde do bebê; e aleitamento materno: significados, expectativas e a rede de apoio à mulher. Nove puérperas receberam orientações sobre aleitamento materno no pré-natal, mas a maioria relatou não ter sido orientada sobre isso. O estudo ratifica a importância da orientação nutricional durante o pré-natal, apontando a necessidade de conhecer a visão da mulher sobre esse período.
ObjectiveThe aim of this study is to develop and validate a prediction model for fall risk factors in hospitalized older adults with osteoporosis.MethodsA total of 615 older adults with osteoporosis hospitalized at a tertiary (grade 3A) hospital in Nantong City, Jiangsu Province, China, between September 2022 and August 2023 were selected for the study using convenience sampling. Fall risk factors were identified using univariate and logistic regression analyses, and a predictive risk model was constructed and visualized through a nomogram. Model performance was evaluated using the area under the receiver operator characteristic curve (AUC), Hosmer-Lemeshow goodness-of-fit test, and clinical decision curve analysis, assessing the discrimination ability, calibration, and clinical utility of the model.ResultsBased on logistic regression analysis, we identified several significant fall risk factors for older adults with osteoporosis: gender of the study participant, bone mineral density, serum calcium levels, history of falls, fear of falling, use of walking aids, and impaired balance. The AUC was 0.798 (95% CI: 0.763–0.830), with a sensitivity of 80.6%, a specificity of 67.9%, a maximum Youden index of 0.485, and a critical threshold of 121.97 points. The Hosmer-Lemeshow test yielded a χ2 value of 8.147 and p = 0.419, indicating good model calibration. Internal validation showed a C-index of 0.799 (95% CI: 0.768–0.801), indicating the model’s high discrimination ability. Calibration curves showed good agreement between predicted and observed values, confirming good calibration. The clinical decision curve analysis further supported the model’s clinical utility.ConclusionThe prediction model constructed and verified in this study was to predict fall risk for hospitalized older adults with osteoporosis, providing a valuable tool for clinicians to implement targeted interventions for patients with high fall risks.
Robert D Brook, Pia-Allison Roa, Phillip D Levy
et al.
Background: Fine particulate matter <2.5 µm (PM2.5) air pollution increases cardio-pulmonary morbidity and mortality. To inform the public regarding local air quality and reduce short-term exposures to PM2.5, daily Air Quality Indices (AQIs) with activity guidance are issued across the United States (US). We aimed to estimate the cardio-pulmonary health benefits of the current AQI strategy. Methods: We estimated the number needed to treat (NNT) per county per day to avoid 1 atherosclerotic cardiovascular disease (ASCVD) or pulmonary event during each PM2.5 AQI action day (defined as a day with an AQI >100 for PM2.5) for 3 groups (healthy adults, ASCVD and pulmonary disease patients) in the US during 2022. The theoretical number of adverse events potentially prevented per county was estimated each day as the relevant county population divided by the corresponding NNT. These results were summed for all AQI action days among US counties to equal the potential total number of ASCVD and pulmonary events avoided nationwide. Results: There were 1081 AQI action days for PM2.5 (58.0 ± 32.4 µg/m3) across 236 counties in 2022, accounting for an estimated excess of 164 ASCVD and 3963 pulmonary events. Approximately 31 ASCVD and 796 pulmonary events could be theoretically avoided if all populations followed activity guidelines during every AQI action day. Conclusions: Daily AQI activity guidelines, as currently structured and implemented, likely prevent few cardio-pulmonary events per year in the US. Additional research is warranted to determine how to improve the overall approach to more effectively protect public health.
Diseases of the circulatory (Cardiovascular) system, Public aspects of medicine
Chao‐Wen Chen, Yung‐Sung Yeh, Ta‐Chien Chan
et al.
Abstract Introduction The acute care system faced significant challenges in managing healthcare emergencies due to a lack of coordination between emergency services and logistical support. This disorganization undermined collaboration and response efficiency. Methods Taiwan's Presidential Hackathon introduced an innovative approach to improving the trauma system by integrating digital pipeline science through public–private partnerships (PPPs). This initiative specifically addressed inefficiencies and complexities in the acute care ecosystem, brought to light by the catastrophic 2014 gas explosion in Kaohsiung City. Results The hackathon led to the development of a unified digital platform for emergency data management. This platform significantly enhanced communication, data sharing, and coordination across healthcare sectors, culminating in the implementation of a digital pre‐hospital emergency care system across multiple administrative regions. Conclusion Our experience demonstrated the effectiveness of leveraging digital technologies, PPPs, and the hackathon model to revolutionize emergency healthcare management and response systems through cross‐sector collaboration.
Cristiani Vieira Machado, Adelyne Maria Mendes Pereira, Carlos Machado de Freitas
et al.
Abstract: The article analyzes the fight against COVID-19 in three Latin American countries: Argentina, Brazil, and Mexico. A multiple case study was carried out in a comparative perspective, based on a bibliographic review, documentary analysis, and secondary data, considering characteristics of the countries and the health system, evolution of COVID-19, national governance, containment and mitigation measures, health systems response, constraints, positive aspects and limits of responses. The three countries had distinct health systems but were marked by insufficient funding and inequalities when hit by the pandemic and recorded high-COVID-19 mortality. Structural, institutional, and political factors influenced national responses. In Argentina, national leadership and intergovernmental political agreements favored the initial adoption of centralized control measures, which were not sustained. In Brazil, there were limits in national coordination and leadership related to the President’s denialism and federative, political, and expert conflicts, despite a universal health system with intergovernmental commissions and participatory councils, which were little used during the pandemic. In Mexico, structural difficulties were associated with the Federal Government’s initial reluctance to adopt restrictive measures, limits on testing, and relative slowness in immunization. In conclusion, facing health emergencies requires strengthening public health systems associated with federative, intersectoral, and civil society coordination mechanisms and effective global solidarity mechanisms.
BackgroundSleep is an important physiological behavior in humans that is associated with the occurrence and development of various diseases. However, the association of sleep duration with health-related outcomes, including obesity-related factors, musculoskeletal diseases, and mortality because of different causes, has not been systematically reported.
ObjectiveThis study aims to systematically investigate the effect of sleep duration on health-related outcomes.
MethodsOverall, 54,664 participants with sleep information from 8 survey cycles of the National Health and Nutrition Examination Survey (2005-2020) were included in the analysis. Health-related outcomes comprised obesity-related outcomes (ie, BMI, obesity, waist circumference, and abdominal obesity), metabolism-related outcomes (ie, uric acid, hyperuricemia, and bone mineral density [BMD]), musculoskeletal diseases (ie, osteoarthritis [OA] and rheumatoid arthritis [RA]), and mortality because of different causes. The baseline information of participants including age, sex, race, educational level, marital status, total energy intake, physical activity, alcohol consumption, smoking, hypertension, and diabetes was also collected as covariates. Information about the metabolism index, disease status, and covariates was acquired from the laboratory, examination, and questionnaire data. Survival information, including survival status, duration, and cause of death, was obtained from the National Death Index records. Quantile regression models and Cox regression models were used for association analysis between sleep duration and health-related outcomes. In addition, the threshold effect analysis, along with smooth curve fitting method, was applied for the nonlinear association analysis.
ResultsParticipants were divided into 4 groups with different sleep durations. The 4 groups showed significant differences in terms of baseline data (P<.001). The quantile regression analysis indicated that participants with increased sleep duration showed decreased BMI (β=−.176, 95% CI −.220 to −.133; P<.001), obesity (odds ratio [OR] 0.964, 95% CI 0.950-0.977; P<.001), waist circumference (β=−.219, 95% CI −.320 to −.117; P<.001), abdominal obesity (OR 0.975, 95% CI 0.960-0.990; P<.001), OA (OR 0.965, 95% CI 0.942-0.990; P=.005), and RA (OR 0.940, 95% CI 0.912-0.968; P<.001). Participants with increased sleep duration also showed increased BMD (β=.002, 95% CI .001-.003; P=.005), as compared with participants who slept <5.5 hours. A significant saturation effect of sleep duration on obesity, abdominal obesity, and hyperuricemia was detected through smooth curve fitting and threshold effect analysis (sleep duration>inflection point). In addition, a significant threshold effect of sleep duration on BMD (P<.001); OA (P<.001); RA (P<.001); and all-cause (P<.001), cardiovascular disease−cause (P<.001), cancer-cause (P=.005), and diabetes-cause mortality (P<.001) was found. The inflection point was between 6.5 hours and 9 hours.
ConclusionsThe double-edged sword effect of sleep duration on obesity-related outcomes, embolism-related diseases, musculoskeletal diseases, and mortality because of different causes was detected in this study. These findings provided epidemiological evidence that proper sleep duration may be an important factor in the prevention of multisystem diseases.
Silvia Y. Vargas-Roldán, José L. Lezana-Fernández, Jorge F. Cerna-Cortés
et al.
La fibrosis quística es una enfermedad hereditaria autosómica recesiva que se origina por mutaciones en el gen regulador de conductancia transmembranal de la fibrosis quística (CFTR, cystic fibrosis transmembrane conductance regulator). El CFTR es una proteína que transporta iones a través de la membrana de las células epiteliales pulmonares. La pérdida de su función conlleva la producción de un moco pegajoso y espeso, donde se pueden establecer y adaptar diversos patógenos bacterianos que contribuyen a la pérdida gradual de la función pulmonar. En este artículo de revisión se dará evidencia de los mecanismos moleculares que utilizan Pseudomonas aeruginosa y Burkholderia cenocepacia para sobrevivir y persistir en el ambiente pulmonar. Adicionalmente, se describirán las nuevas estrategias de terapia a base de moduladores de la función del CFTR.