Evaluación y acreditación de las aplicaciones móviles relacionadas con la salud

Las aplicaciones móviles relacionadas con la salud han incrementado su presencia en el mercado y su uso, cada vez más frecuente, forma parte de la vida cotidiana de una gran mayoría de ciudadanos. La tecnología móvil puede suponer una importante innovación en la asistencia médica, ya que pueden ayudar al paciente a tener un control más activo de su enfermedad, dado que se fomenta el autocuidado y el empoderamiento. Sin embargo, el empleo de este tipo de herramientas tecnológicas aún es lento y limitado. En este contexto surgen dudas sobre la calidad, fiabilidad y utilidad clínica de las aplicaciones móviles debido, principalmente, a la falta de evaluación y acreditación de las mismas. En el presente estudio se analizaron las iniciativas más destacadas de evaluación y acreditación de aplicaciones móviles a nivel nacional e internacional, así como las escalas más usadas para evaluar este tipo de tecnologías. Mobile applications related to health have increased their presence in the market and their use, increasingly frequent, is part of the daily life of a large majority of citizens. Mobile technology can be an important innovation in medical care, since it can help the patient to have more active control of their disease, because it promotes self-care and empowerment. However, the use of this type of technological tools is still slow and limited. In this situation, questions arise regarding the quality, reliability and clinical utility of mobile applications and a factor that contributes to this uncertainty is related to the lack of evaluation and accreditation of them. This paper analyzed the most outstanding initiatives for the evaluation and accreditation of mobile applications at the national and international level, as well as the most widely used scales to evaluate this type of technology

Functional Effect of the p22phox -930A/G Polymorphism on p22phox Expression and NADPH Oxidase Activity in Hypertension

Oxidative stress induced by superoxide is implicated in hypertension. NADPH oxidase is the main source of superoxide in phagocytic and vascular cells, and the p22phox subunit is involved in NADPH oxidase activation. Recently we reported an association of 930A/G polymorphism in the human p22phox gene promoter with hypertension. This study was designed to investigate the functional role of this polymorphism in hypertension. We thus investigated the relationships between the 930A/G polymorphism and p22phox expression and NADPH oxidase–mediated superoxide production in phagocytic cells from 70 patients with essential hypertension and 70 normotensive controls. Genotyping of the polymorphism was performed by restriction fragment length polymorphism. NADPH oxidase activity was determined by chemiluminescence assays, and p22phox mRNA and protein expression was measured by Northern and Western blotting, respectively. Compared with hypertensive subjects with the AA/AG genotype, hypertensive subjects with the GG genotype exhibited increased (P 0.05) phagocytic p22phox mRNA (1.26 0.06 arbitrary unit [AU] versus 0.99 0.03 AU) and protein levels (0.58 0.05 AU versus 0.34 0.04 AU) and enhanced NADPH oxidase activity (1998 181 counts/s versus 1322 112 counts/s). No differences in these parameters were observed among genotypes in normotensive cells. Transfection experiments on vascular smooth muscle cells showed that the A-to-G substitution of this polymorphism produced an increased reporter gene expression in hypertensive cells. Nitric oxide production, as assessed by measurement of serum nitric oxide metabolites, was lower in GG hypertensive subjects than in AA/AG hypertensive subjects. In conclusion, these results suggest that hypertensive subjects carrying the GG genotype of the p22phox 930A/G polymorphism are highly exposed to NADPH oxidase-mediated oxidative stress

¿Es realmente fiable la evaluación no individualizada en el trabajo cooperativo?

Se presentan y discuten los resultados de una experiencia de trabajo cooperativo empleando la plataforma BSCW en alumnos de la titulación de Maestro de Educación Infantil de la Universidad de Barcelona, con el fin de detectar posibles sesgos de las coevaluaciones y las autoevaluaciones, y para valorar la incidencia que tienen los comportamientos disruptivos en el proceso cooperativo de evaluación. Los resultados muestran que el alumnado es honesto en las calificaciones que otorga, y que los comportamientos disruptivos detectados en los distintos grupos de trabajo cooperativo, causados por una baja ciudadanía de equipo, no tienen una incidencia significativa en las calificaciones otorgadas por el grupo clase. Por tanto, se legitiman las coevaluaciones y las autoevaluaciones como instrumentos fiables de evaluación en un contexto de trabajo cooperativo

Establishing comprehensive oral assessments for children with safeguarding concerns.

The dental profession is well placed to contribute important information in child protection cases but no previous research has been reported that assesses the volume or impact of this information. Comprehensive oral assessment clinics were introduced and established as an integral part of comprehensive medical assessments for children with welfare concerns in Greater Glasgow and Clyde. An assessment protocol and standardised paperwork for comprehensive oral assessments were developed to enhance information sharing and patient access to appropriate care. Two cases are presented and discussed to demonstrate the value of dental input

Association of increased phagocytic NADPH oxidasedependent superoxide production with diminished nitric oxide generation in essential hypertension

Objective: Oxidative stress has been implicated in the pathogenesis of hypertension and its complications through alterations in nitric oxide (NO) metabolism. This study was designed to investigate whether a relationship exists between phagocytic nicotinamide adenine dinucleotide phosphate (NADPH) oxidase-dependent superoxide anion (•O2-) production and NO generation in patients with essential hypertension. Methods: Superoxide production was assayed by chemiluminescence under baseline and stimulated conditions on mononuclear cells obtained from hypertensives (n = 51) and normotensives (n = 43). NO production was evaluated by determining serum NO metabolites, nitrate plus nitrite (NOx). Results: Although there were no differences in baseline •O2- production between normotensives and hypertensives, the •O2- production in phorbol myristate acetate (PMA)-stimulated mononuclear cells was increased (P < 0.05) in hypertensives compared with normotensives. The PMA-induced •O2- production was completely abolished by apocynin, a specific inhibitor of NADPH oxidase. Moreover, stimulation of •O2- production by angiotensin II and endothelin-1 was higher (P < 0.05) in cells from hypertensives than in cells from normotensives. In addition, diminished (P < 0.001) serum NOx was detected in hypertensives compared with normotensives. Interestingly, an inverse correlation (r = 0.493, P < 0.01) was found between •O2- production and NOx in hypertensives. Conclusions: Generation of •O2- mainly dependent on NADPH oxidase is abnormally enhanced in stimulated mononuclear cells from hypertensives. It is suggested that this alteration could be involved in the diminished NO production observed in these patients

Construcción de un índice de privación por zona básica de salud en Aragón a partir de datos de censo de 2011

Fundamentos: La medición de las desigualdades mediante indicadores compuestos facilita la priorización y puesta en marcha de acciones de salud pública. La fuente de información más comúnmente utilizada para ello ha sido el Censo de Población y viviendas de 2011 (CPV_2011). El objetivo fue validar la utilización del CPV_2011 por Zona de Salud (ZBS) y construir un índice de privación (IP) por ZBS así como analizar su asociación con la mortalidad en Aragón. Métodos: Estudio ecológico por ZBS. El CPV_2011, con diseño muestral, se validó mediante un test de homogeneidad de Chi_cuadrado y se calcularon 26 indicadores socioeconómicos. Se obtuvo el coeficiente de correlación de Spearman entre indicadores socioeconómicos y Razones de Mortalidad Estandarizadas (REM). Se realizó un análisis de componentes principales (ACP) con los indicadores correlacionados significativamente, extrayendo los componentes con autovalores mayores a 1 y se obtuvo la matriz rotada (Varimax). Se realizaron ACP con las variables de cada componente extrayendo un único factor. Se agruparon las ZBS en cuartiles, según el factor calculando tasas de mortalidad ajustadas a población estándar europea por edad, sexo y cuartil. El factor que más discrimina por cuartiles se consideró IP y se recalculó para ZBS urbanas con idénticas variables. Resultados: La validación de la muestra del CPV_2011, detectó cuatro ZBS infrarrepresentadas. 17 indicadores socioeconómicos se correlacionaron con REM. Del primer ACP se extrajeron 3 componentes, eligiendo como IP, el formado por %Desempleo, %Asalariados eventuales, %Instrucción Insuficiente 16-64 años y %Extranjeros. Las varianzas explicadas fueron 59,7% y 73,8% en el IP urbano. En hombres, la mortalidad en el cuartil menos privado (544,7 por 105; IC95%:515,8-573,6), fue inferior a la del más privado (618,7 por 105; IC95%:589,4,648,0). Conclusiones: El IP permite identificar ZBS desfavorecidas constituyendo una herramienta para evidenciar desigualdades y planificar intervenciones según necesidades. Background: The measurement of inequalities using composite indicators facilitates the prioritization and implementation of public health actions. The most commonly source of information used for this has been the Population and Housing Census of 2011 (PCH_2011). The objective of this study was to evaluate the use of PHC_2011 and develop a deprivation index (DI) by Basic Healthcare Area (BHA) and to analyse its association with mortality in Aragon. Methods: Ecological study by BHA. Since PHC_2011 was a sample of the population it was validated by the Chi-square test for homogeneity. 26 socioeconomic indicators were calculated. Spearman correlation coefficients were used to evaluate the relationship between socioeconomic indicators and Standardized Mortality Ratios (SMR). Principal Component Analyses (PCA) were conducted using the indicators in which a significant correlation was found. Components with eigenvalues higher than 1 were extracted, and the rotated matrix (Varimax) was obtained. PCA from each component were conducted, extracting only one factor. BHA were grouped into, according to the deprivation index values. Mortality rates adjusted to the European Standard Population by age, sex and quartile were calculated. The most discriminant factor by quartiles was considered DI. A different DI for urban areas was obtained from the same variables. Results: The validation of PHC sample detected 4 underrepresented BHA. 17 socioeconomic indicators were significatively correlated with SMR. From the first PCA, 3 components were obtained. The DI included % unemployment, % eventual workers, % insufficient education 16-64 years old and % foreigners. The % of variance explained by the DI was 59.7% and 73.8% in urban areas. In men, mortality in the quartile with the lowest deprivation (544, 7 per 105; CI95%: 515, 8-573, 6) was significatively lower than in the most deprivated areas(618, 7 per 105; CI95%: 589, 4-648, 0). Conclusions: This new DI allows us to identify deprived BHA. This is a useful tool to bring to light health inequalities and to plan interventions according to population's needs

Cause of Death and Predictors of All-Cause Mortality in Anticoagulated Patients With Nonvalvular Atrial Fibrillation : Data From ROCKET AF

M. Kaste on työryhmän ROCKET AF Steering Comm jäsen.Background-Atrial fibrillation is associated with higher mortality. Identification of causes of death and contemporary risk factors for all-cause mortality may guide interventions. Methods and Results-In the Rivaroxaban Once Daily Oral Direct Factor Xa Inhibition Compared with Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation (ROCKET AF) study, patients with nonvalvular atrial fibrillation were randomized to rivaroxaban or dose-adjusted warfarin. Cox proportional hazards regression with backward elimination identified factors at randomization that were independently associated with all-cause mortality in the 14 171 participants in the intention-to-treat population. The median age was 73 years, and the mean CHADS(2) score was 3.5. Over 1.9 years of median follow-up, 1214 (8.6%) patients died. Kaplan-Meier mortality rates were 4.2% at 1 year and 8.9% at 2 years. The majority of classified deaths (1081) were cardiovascular (72%), whereas only 6% were nonhemorrhagic stroke or systemic embolism. No significant difference in all-cause mortality was observed between the rivaroxaban and warfarin arms (P=0.15). Heart failure (hazard ratio 1.51, 95% CI 1.33-1.70, P= 75 years (hazard ratio 1.69, 95% CI 1.51-1.90, P Conclusions-In a large population of patients anticoagulated for nonvalvular atrial fibrillation, approximate to 7 in 10 deaths were cardiovascular, whereasPeer reviewe

Business analytics in industry 4.0: a systematic review

Recently, the term “Industry 4.0” has emerged to characterize several Information Technology and Communication (ICT) adoptions in production processes (e.g., Internet-of-Things, implementation of digital production support information technologies). Business Analytics is often used within the Industry 4.0, thus incorporating its data intelligence (e.g., statistical analysis, predictive modelling, optimization) expert system component. In this paper, we perform a Systematic Literature Review (SLR) on the usage of Business Analytics within the Industry 4.0 concept, covering a selection of 169 papers obtained from six major scientific publication sources from 2010 to March 2020. The selected papers were first classified in three major types, namely, Practical Application, Reviews and Framework Proposal. Then, we analysed with more detail the practical application studies which were further divided into three main categories of the Gartner analytical maturity model, Descriptive Analytics, Predictive Analytics and Prescriptive Analytics. In particular, we characterized the distinct analytics studies in terms of the industry application and data context used, impact (in terms of their Technology Readiness Level) and selected data modelling method. Our SLR analysis provides a mapping of how data-based Industry 4.0 expert systems are currently used, disclosing also research gaps and future research opportunities.The work of P. Cortez was supported by FCT - Fundação para a Ciência e Tecnologia within the R&D Units Project Scope: UIDB/00319/2020. We would like to thank to the three anonymous reviewers for their helpful suggestions