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BACKGROUND: The burden of disease of diabetes in Colombia have increased in the last decades. Secondary prevention is crucial for diabetes control. Many patients already treated remain with poor glycemic control and without timely and appropriate treatment intensification. This has been called in the literature as Clinical Inertia. Updated information regarding clinical inertia based on the Colombian diabetes treatment guidelines is needed. OBJECTIVE: To measure the prevalence of clinical inertia in newly diagnosed Type 2 Diabetes Mellitus (T2DM) patients in healthcare institutions in Colombia, based on the recommendations of the current official guidelines. METHODS: An observational and retrospective cohort study based on databases of two Health Medical Organizations (HMOs) in Colombia (one from subsidized regimen and one from contributory regimen) was conducted. Descriptive analysis was performed to summarize demographic and clinical information. Chi-square tests were used to assess associations between variables of interest. RESULTS: A total of 616 patients with T2DM (308 for each regimen) were included. Median age was 61 years. Overall clinical inertia was 93.5% (87.0% in contributory regimen and 100% in subsidized regimen). Patients with Hb1Ac ≥ 8% in the subsidized regimen were more likely to receive monotherapy than patients in the contributory regimen (OR 2.33; 95% CI 1.41-3.86). CONCLUSIONS: In this study, the prevalence of overall clinical inertia was higher in the subsidized regime than in the contributory regime (100% vs 87%). Great efforts have been made to equalize the coverage between the two systems, but this finding is worrisome with respect to the difference in quality of the health care provided to these two populations. This information may help payers and clinicians to streamline strategies for reducing clinical inertia and improve patient outcomes.

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OBJECTIVE: To validate hemoglobin (Hb) concentration in venous blood (VB) using the HemoCue 201+ in a subsample of children and women from the Mexican National Health and Nutrition Survey 2022. MATERIALS AND METHODS: Prior to field work 50 HemoCue 201+ devices were verified using venous blood. During the field work 57 children (aged 1-11) and 62 women (aged 12-49) donated 3 mL of VB each. Hb was measured in each device of HemoCue 201+ and in a hematologic autoanalyzer for the validation. RESULTS: No significant bias was found in most of the devices. An adjustment criterion was used for 22 devices. Hb mean difference results were -0.049±0.578 g/dL in children and -0.098±0.628 g/dL in women. CONCLUSIONS: The HemoCue 201+ is a valid tool for estimating Hb concentration to produce reliable estimates of anemia prevalence when using venous blood.

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Background: The prevalence of post-COVID-19 Syndrome (PCS) is estimated to be between 10% and 20%. The main reported symptoms are fatigue, memory alterations, dyspnea, sleep disorders, arthralgia, anxiety, taste alterations, coughing and depression. This study aims to determine the prevalence of post-COVID-19 symptoms in a group of Colombian patients who were recruited during their outpatient appointments. Methodology: This cross-sectional study was conducted between December 2021 to May 2022. It included patients from outpatient facilities located in five main cities in Colombia who were positive for SARS-CoV-2 infection detected by reverse transcription-polymerase chain reaction (RT-PCR) testing and reported PCS in the following 12 weeks after their COVID-19 diagnosis. Results: A total of 1047 individuals >18 years old met the inclusion criteria and were included in the study. The median age was 46 years old. 68.2% of the participants were female, 41.5% of the patients reported having a pre-existent condition (hypertension, anxiety disorder, diabetes, hyperthyroidism, obesity and asthma). Only 22% had received at least one dose of COVID-19 vaccine prior to the COVID-19 episode registered. The more prevalent symptoms within our group are described as follows: fatigue (53.3%), dyspnea (40.3%), arthralgia and/or myalgia (43%), cephalea (40.5%), sleep disorders (35.7%) and coughing (31.3%). 72% of the patients presented four or more post-COVID 19 symptoms, 9% two symptoms, and 10% only one symptom. Conclusion: The findings of this study are consistent with international literature publicly available. The distribution and prevalence of post-COVID symptoms highlight the importance of further research to improve understanding and its potential consequences and implications in terms of quality of life and health care planning services.

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OBJECTIVE: To estimate the frequency of detection and levels of aflatoxin B1-lysine adduct (AFB1-lys), an important hepatocellular carcinoma (HCC) risk factor, in eastern and southern Mexico. MATERIALS AND METHODS: We determined serum AFB1-lys using mass spectrometry in a representative sample of 952 adults (weighted n = 7,493,354) from five states (Campeche, Chiapas, Tamaulipas, Veracruz and Yucatán) in 2018. We calculated overall and subgroup-specific frequency of detection and 95% confidence intervals (95%CI) and median AFB1-lys levels and quartiles. RESULTS: The overall frequency of detection of AFB1-lys was 91.9% (95%CI 88.6, 94.3). The median AFB1-lys level was 0.172 pg/µL (Q1-Q3, 0.060-0.582). Levels differed geographically (median pg/µL, 0.361 for Veracruz and 0.061 for Yucatan) and were higher among men and older individuals. Levels were almost three times higher in rural relative to urban areas (0.317 vs. 0.123 pg/µL). We observed higher AFB1-lys exposure in lower socioeconomic status (SES) level populations. CONCLUSION: AFB1-lys frequency of detection was very high and exposure levels were highest in Veracruz, men, rural areas, and among persons of lower SES. Understanding modifiable HCC risk factors in populations with unique epidemiological patterns could inform preventative interventions.

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Introduction: Prostate cancer has increased in recent years, increasing the costs associated with its treatment. Second-generation oral antiandrogens have emerged as an attractive therapeutic option. Objective: To compare the health value provided by enzalutamide and apalutamide, by evaluating two stages of prostate cancer: non-metastatic castration-resistant prostate cancer (nmCRPC) and metastatic hormone-sensitive prostate cancer (mHSPC). Methods: To establish, through the American Society of Clinical Oncology (ASCO) value framework, a contrast between two technologies in two stages of prostate cancer. The monthly cost of the two technologies was calculated according to the current price regulation norm in Colombia. Results: Enzalutamide showed a higher net health benefit score compared to apalutamide for both nmCRPC (48.33 versus 33.46) and mHSPC (52.0 versus 40.75). The cost per net health benefit point for the nmCRPC stage was $214,723 Colombian Pesos (COP) ($54.84 USD) with enzalutamide compared to $291,925 COP ($74.56 USD) with apalutamide, and for the mHSPC stage was $199,692 COP ($51.00 USD) with enzalutamide and $239,701 COP ($61.22 USD) with apalutamide. Conclusion: After comparing enzalutamide versus apalutamide in the nmCRPC and mHSPC stages through the ASCO value framework, enzalutamide showed a more prominent net clinical benefit and a lower investment per point awarded.

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[This corrects the article DOI: 10.3389/ijph.2022.1604626.].

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The unusual arrival of Sargassum on Caribbean beaches is an emerging problem that has generated numerous challenges. The monitoring, visualization, and estimation of Sargassum coverage on the beaches remain a constant complication. This study proposes a new mapping methodology to estimate Sargassum coverage on the beaches. Semantic segmentation of geotagged photographs allows the generation of accurate maps showing the percent coverage of Sargassum. The first dataset of segmented Sargassum images was built for this study and used to train the proposed model. The results demonstrate that the currently proposed method has an accuracy of 91%, improving on the results reported in the state-of-the-art method where data was also collected through a crowdsourcing scheme, in which only information on the presence and absence of Sargassum is displayed.

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Objective: The global COVID-19 pandemic has challenged health systems. Healthcare professionals had to face harsh conditions that have caused psycho-emotional consequences. Ecuador has been one of the countries hit hardest by the pandemic in Latin America. The objective of this study was to analyse the levels of psychological distress among healthcare workers in Ecuador during the COVID-19 pandemic. Methods: A cross-sectional descriptive study was conducted with a convenience sample of 1,056 healthcare professionals, assessing their psychological distress, physical symptoms of COVID-19, state of health, the preventive measures adopted, and the history of contact with people infected with the SARS-CoV2 virus. Results: showed that 66.0% of the participants manifested psychological distress, with significantly higher levels in women with symptoms of COVID-19 and previous contact with infected people or objects (p < 0.001). However, adherence to preventive measures and perception of health were associated with less psychological distress (p < 0.001). Conclusions: The importance of monitoring the mental health of healthcare workers during the COVID-19 pandemic was confirmed, having identified factors associated with the development of psychological distress among professionals in Ecuador.

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The spread of the Coronavirus (COVID-19) pandemic across countries all over the world urges governments to revolutionize the traditional medical hospitals/centers to provide sustainable and trustworthy medical services to patients under the pressure of the huge overload on the computing systems of wireless sensor networks (WSNs) for medical monitoring as well as treatment services of medical professionals. Uncertain malfunctions in any part of the medical computing infrastructure, from its power system in a remote area to the local computing systems at a smart hospital, can cause critical failures in medical monitoring services, which could lead to a fatal loss of human life in the worst case. Therefore, early design in the medical computing infrastructure's power and computing systems needs to carefully consider the dependability characteristics, including the reliability and availability of the WSNs in smart hospitals under an uncertain outage of any part of the energy resources or failures of computing servers, especially due to software aging. In that regard, we propose reliability and availability models adopting stochastic Petri net (SPN) to quantify the impact of energy resources and server rejuvenation on the dependability of medical sensor networks. Three different availability models (A, B, and C) are developed in accordance with various operational configurations of a smart hospital's computing infrastructure to assimilate the impact of energy resource redundancy and server rejuvenation techniques for high availability. Moreover, a comprehensive sensitivity analysis is performed to investigate the components that impose the greatest impact on the system availability. The analysis results indicate different impacts of the considered configurations on the WSN's operational availability in smart hospitals, particularly 99.40%, 99.53%, and 99.64% for the configurations A, B, and C, respectively. This result highlights the difference of 21 h of downtime per year when comparing the worst with the best case. This study can help leverage the early design of smart hospitals considering its wireless medical sensor networks' dependability in quality of service to cope with overloading medical services in world-wide virus pandemics.

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