Use of m-Health Technology for Preventive Interventions to Tackle Cardiometabolic Conditions and Other Non-Communicable Diseases in Latin America- Challenges and Opportunities

In Latin America, cardiovascular disease (CVD) mortality rates will increase by an estimated 145% from 1990 to 2020. Several challenges related to social strains, inadequate public health infrastructure, and underfinanced healthcare systems make cardiometabolic conditions and non-communicable diseases (NCDs) difficult to prevent and control. On the other hand, the region has high mobile phone coverage, making mobile health (mHealth) particularly attractive to complement and improve strategies toward prevention and control of these conditions in low- and middle-income countries. In this article, we describe the experiences of three Centers of Excellence for prevention and control of NCDs sponsored by the National Heart, Lung, and Blood Institute with mHealth interventions to address cardiometabolic conditions and other NCDs in Argentina, Guatemala, and Peru. The nine studies described involved the design and implementation of complex interventions targeting providers, patients and the public. The rationale, design of the interventions, and evaluation of processes and outcomes of each of these studies are described, together with barriers and enabling factors associated with their implementation.Fil: Beratarrechea, Andrea Gabriela. Instituto de Efectividad Clínica y Sanitaria; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Diez Canseco, Francisco. Universidad Peruana Cayetano Heredia; PerúFil: Irazola, Vilma. Instituto de Efectividad Clínica y Sanitaria; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Miranda, Jaime. Universidad Peruana Cayetano Heredia; PerúFil: Ramirez Zea, Manuel. Institute of Nutrition of Central America and Panama; GuatemalaFil: Rubinstein, Adolfo Luis. Instituto de Efectividad Clínica y Sanitaria; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentin

Evaluating the Performance of Infectious Disease Forecasts: A Comparison of Climate-Driven and Seasonal Dengue Forecasts for Mexico

Dengue viruses, which infect millions of people per year worldwide, cause large epidemics that strain healthcare systems. Despite diverse efforts to develop forecasting tools including autoregressive time series, climate-driven statistical, and mechanistic biological models, little work has been done to understand the contribution of different components to improved prediction. We developed a framework to assess and compare dengue forecasts produced from different types of models and evaluated the performance of seasonal autoregressive models with and without climate variables for forecasting dengue incidence in Mexico. Climate data did not significantly improve the predictive power of seasonal autoregressive models. Short-term and seasonal autocorrelation were key to improving short-term and long-term forecasts, respectively. Seasonal autoregressive models captured a substantial amount of dengue variability, but better models are needed to improve dengue forecasting. This framework contributes to the sparse literature of infectious disease prediction model evaluation, using state-of-the-art validation techniques such as out-of-sample testing and comparison to an appropriate reference model

Characterizing the Information Needs of Rural Healthcare Practitioners with Language Agnostic Automated Text Analysis

Objectives – Previous research has characterized urban healthcare providers\u27 information needs, using various qualitative methods. However, little is known about the needs of rural primary care practitioners in Brazil. Communication exchanged during tele-consultations presents a unique data source for the study of these information needs. In this study, I characterize rural healthcare providers\u27 information needs expressed electronically, using automated methods. Methods – I applied automated methods to categorize messages obtained from the telehealth system from two regions in Brazil. A subset of these messages, annotated with top-level categories in the DeCS terminology (the regional equivalent of MeSH), was used to train text categorization models, which were then applied to a larger, unannotated data set. On account of their more granular nature, I focused on answers provided to the queries sent by rural healthcare providers. I studied these answers, as surrogates for the information needs they met. Message representations were generated using methods of distributional semantics, permitting the application of k-Nearest Neighbor classification for category assignment. The resulting category assignments were analyzed to determine differences across regions, and healthcare providers. Results – Analysis of the assigned categories revealed differences in information needs across regions, corresponding to known differences in the distributions of diseases and tele-consultant expertise across these regions. Furthermore, information needs of rural nurses were observed to be different from those documented in qualitative studies of their urban counterparts, and the distribution of expressed information needs categories differed across types of providers (e.g. nurses vs. physicians). Discussion – The automated analysis of large amounts of digitally-captured tele-consultation data suggests that rural healthcare providers\u27 information needs in Brazil are different than those of their urban counterparts in developed countries. The observed disparities in information needs correspond to known differences in the distribution of illness and expertise in these regions, supporting the applicability of my methods in this context. In addition, these methods have the potential to mediate near real-time monitoring of information needs, without imposing a direct burden upon healthcare providers. Potential applications include automated delivery of needed information at the point of care, needs-based deployment of tele-consultation resources and syndromic surveillance. Conclusion – I used automated text categorization methods to assess the information needs expressed at the point of care in rural Brazil. My findings reveal differences in information needs across regions, and across practitioner types, demonstrating the utility of these methods and data as a means to characterize information needs

Microspatial Distributional Patterns of Vectors of Cutaneous Leishmaniasis in Pernambuco, Northeastern Brazil

This is the publisher's version, also available electronically from http://www.hindawi.com/journals/jtm/2012/642910/abs/The purpose of this study is to analyze the spatial distribution and population trends through time of Lutzomyia species in a long-term focus of cutaneous leishmaniasis transmission in an Atlantic Forest area, northeastern Brazil. Sand fly populations of different ecological niches were monitored spatiotemporally in 2009. To summarize vegetation characteristics and phenology, we calculated the Normalized Difference Vegetation Index from Landsat images. Using niche modeling approaches, we assessed suites of environmental factors to identify areas of transmission risk. Although 12 species were detected, L. whitmani was the most abundant and broadly distributed across the area, particularly in peridomiciliary locations, and associated negatively with denser vegetation areas. On the other hand, L. complexa, L. sordelli, and L. tupynambai were found almost exclusively in forested areas ( < 0 . 0 5 ), and associated positively with denser vegetation. Lutzomyia species' occurrences are related to specific environmental combinations (with contrast among species) in the region

Prevalência de programas de promoção da saúde em unidades básicas de saúde no Brasil

OBJECTIVE Assessment of prevalence of health promotion programs in primary health care units within Brazil’s health system. METHODS We conducted a cross-sectional descriptive study based on telephone interviews with managers of primary care units. Of a total 42,486 primary health care units listed in the Brazilian Unified Health System directory, 1,600 were randomly selected. Care units from all five Brazilian macroregions were selected proportionally to the number of units in each region. We examined whether any of the following five different types of health promotion programs was available: physical activity; smoking cessation; cessation of alcohol and illicit drug use; healthy eating; and healthy environment. Information was collected on the kinds of activities offered and the status of implementation of the Family Health Strategy at the units. RESULTS Most units (62.0%) reported having in place three health promotion programs or more and only 3.0% reported having none. Healthy environment (77.0%) and healthy eating (72.0%) programs were the most widely available; smoking and alcohol use cessation were reported in 54.0% and 42.0% of the units. Physical activity programs were offered in less than 40.0% of the units and their availability varied greatly nationwide, from 51.0% in the Southeast to as low as 21.0% in the North. The Family Health Strategy was implemented in most units (61.0%); however, they did not offer more health promotion programs than others did. CONCLUSIONS Our study showed that most primary care units have in place health promotion programs. Public policies are needed to strengthen primary care services and improve training of health providers to meet the goals of the agenda for health promotion in Brazil.OBJETIVO Estimar a prevalência de programas de promoção da saúde nas unidades básicas de saúde no Brasil. MÉTODOS Estudo transversal descritivo realizado por meio de entrevistas telefônicas com coordenadores de unidades básicas de saúde. Do total de 42.486 unidades básicas de saúde cadastradas pelo Ministério da Saúde, 1.600 foram aleatoriamente selecionadas. As unidades foram amostradas nas cinco regiões do País de acordo com a proporção de unidades em cada região. Foi analisada a presença ou não de cinco programas de promoção da saúde: promoção de atividade física, cessação de tabagismo, cessação de uso de álcool e drogas ilícitas, alimentação saudável e ambiente saudável. Foram coletados dados sobre o tipo de ações desenvolvidas nos programas e a presença ou não da Estratégia de Saúde da Família na unidade. RESULTADOS A maioria das unidades básicas de saúde (62,0%) referiu ter pelo menos três programas de promoção da saúde e apenas 3,0% não tinha nenhum. A promoção do ambiente saudável e da alimentação saudável foram os programas mais prevalentes (77,0% e 72,0%, respectivamente), enquanto o controle do tabaco e do álcool foram referidos em 54,0% e 42,0% das unidades de saúde, respectivamente. A promoção de atividade física foi referida em menos de 40,0% das unidades e teve grande variação regional, com prevalência de 51,0% nas unidades do Sudeste e apenas 21,0% nas do Norte. A maioria das unidades de saúde (61,0%) oferecia Estratégia de Saúde da Família, porém não foi verificada maior prevalência de programas de promoção da saúde nessas unidades em relação às outras. CONCLUSÕES Este estudo mostrou que programas de promoção da saúde estão presentes na maioria das unidades básicas de saúde. Políticas públicas devem fortalecer a infraestrutura das unidades básicas de saúde e melhorar a capacitação dos trabalhadores de saúde para executar adequadamente a agenda de promoção de saúde do governo brasileiro

Porque o Brasil não está pronto para a taxonomia do século XXI: uma visão zoológica

Taxonomy has suffered from a lack of funds, attracting fewer students, and has been considered by some a mere descriptive field, a second-class science. Many authors have extensively pointed out the urgency of increasing our knowledge of biodiversity. Recently, a movement integrating researchers, institutes, and collections arose for addressing the biodiversity crisis and raising the status of taxonomy to ‘Big Science’. This article discusses some impediments that are preventing Brazil entering the new era of taxonomy.A taxonomia tem sofrido com a falta de recursos, atraindo menos estudantes, e tem sido considerada por alguns uma área meramente descritiva, uma ciência de segunda classe. Muitos autores têm apontado exaustivamente a necessidade eminente de se aumentar o conhecimento sobre a biodiversidade. Recentemente, um movimento integrando pesquisadores, institutos e coleções surgiu para reagir contra esta crise na biodiversidade e elevar o status da taxonomia para o de ‘Grande Ciência’. Este artigo discute alguns aspectos que estão impedindo o Brasil de entrar na nova era da taxonomia

Evaluation by Geospatial and Spatiotemporal Distribution of Tularemia Cases in Arkansas

Tularemia is a vector-borne disease of global concern with diverse regional foci. Arkansas is an endemic state with differences in case distribution and land suitability supporting host and vector sustainment. The aim of this study was to conduct a geospatial and spatiotemporal assessment of factors associated with case distribution and timeliness and completeness of public reporting. Guided with direction from spatial epidemiology and nidality, referring to the association of ecology, climate, and proximity of disease, analysis included secondary data collected from the Arkansas Department of Health between 1995 and 2018. Using Poisson-based software, 2 clusters were found: a high-risk cluster encompassing 23% of the total population within 24 counties spanning an 8-year period (RR = 4.98, p \u3c 0.05), and a low risk cluster that included 25% of the population within 28 counties during a 12-year period (RR 0.14, p \u3c 0.05). Analysis of ecological data revealed associations between annual precipitation within the high-risk cluster and total number of cases (AUC = 0.716 and AUC = 0.726, respectively) with trends toward higher incidence rates in suitable land cover and moderate to high elevation using maximum entropy software. Analysis of timeliness and completeness revealed gaps for clinical form and transmission mode determination (p \u3c 0.05), while increases in probable cases followed decreases in confirmed cases revealing gaps in laboratory diagnostics. Positive social change necessitates multidisciplinary collaboration between climatologists, clinicians, and epidemiologists to reach high-risk populations and promote educational awareness. The potential for social change includes predictive modeling optimizing funding while representing underserved populations

Oral Health: Work Process and Interdisciplinarity

Objective:&nbsp;To contribute to the debate about tools that favor the organization of the health work process and its interface with interdisciplinary practices. Material and Methods: We opted for a textual construction based on more specific publications on the field of oral health care. Results: The matrix support is configured as a method of inter-professional activity in co-management that aims to favor the qualification of the health care network. From this perspective, it is an interdisciplinary practice capable of integrating two or more areas of knowledge for a better performance of the actors involved in a given organizational and decision-making process, whether in the clinical or health management scope.&nbsp;Conclusion: Matrix support is an essential tool for the practice of managing health services and amplifying interdisciplinary actions