Making decisions in missing person identification cases with low statistical power

acceptedVersio

Chronic widespread pain in spondyloarthritis

The pain associated with spondyloarthritis (SpA) can be intense, persistent and disabling. It frequently has a multifactorial, simultaneously central and peripheral origin, and may be due to currently active inflammation, or joint damage and tissue destruction arising from a previous inflammatory condition. Inflammatory pain symptoms can be reduced by non-steroidal anti-inflammatory drugs, but many patients continue to experience moderate pain due to alterations in the mechanisms that regulate central pain, as in the case of the chronic widespread pain (CWP) that characterises fibromyalgia (FM). The importance of distinguishing SpA and FM is underlined by the fact that SpA is currently treated with costly drugs such as tumour necrosis factor (TNF) inhibitors, and direct costs are higher in patients with concomitant CWP or FM than in those with FM or SpA alone. Optimal treatment needs to take into account symptoms such as fatigue, mood, sleep, and the overall quality of life, and is based on the use of tricyclic antidepressants or selective serotonin reuptake inhibitors such as fluoxetine, rather than adjustments in the dose of anti-TNF agents or disease-modifying drugs

Gubernamentalidad sanitaria poscovid: Tecnologías para el control, monitoreo y vigilancia de la salud en el municipio de José C. Paz

La pandemia de COVID-19 ha causado una disrupción global en la sociedad y particularmente en sus sistemas de atención médica. A raíz de esto, el uso de la tecnología se aceleró a un ritmo vertiginoso. Las tecnologías sanitarias (TS) se expresan en un conjunto bastante heterogéneo de dispositivos que abarcan desde apps, líneas telefónicas, consultas por videoconferencias, chatbots, recetas electrónicas, resultados de exámenes a través de la red, entre otros. En el campo de la salud, las TS se habían empezado a implementar mundialmente, pero la rápida propagación del SARS-COV-2 ha proporcionado la oportunidad para adoptar plenamente su uso como políticas públicas en el diagnóstico, seguimiento, prevención, cuidado y vigilancia de la salud. En Argentina la pandemia de COVID-19 generó un nuevo portafolio de políticas públicas intersectoriales e interjurisdiccionales modificando las estrategias gubernamentales de todo el país durante el 2020 y el 2021. Las soluciones para administrar la pandemia instalaron a la salud como bien público prioritario e impulsó la reorganización de la gestión de los recursos públicos y privados para la atención sanitaria, independiente de la propia organización y fragmentación característicos de nuestro sistema sanitario. Particularmente, la provincia de Buenos Aires desplegó un conjunto de tecnologías sanitarias (TS) para coordinar la gestión integral del sistema de salud e impulsar una nueva gobernabilidad en ese campo. Las TS ayudaron a construir mecanismos de coordinación y cooperación intersectorial e interjurisdiccional que facilitaron la prevención, el cuidado y el seguimiento de la salud de millones de ciudadanos bonaerenses. Este artículo presenta los resultados de una evaluación del proceso de implementación de las TS, particularmente de la línea telefónica 148, tomando la información cuantitativa georreferenciada y disponible del Ministerio de Salud de la Provincia de Buenos Aires, particularmente del Municipio de José C. Paz, durante los años 2020 y 2021.Fil: Belardo, Marcela Beatriz. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad Nacional de Jose Clemente Paz. Instituto de Estudios Sociales En Contextos de Desigualdades.; ArgentinaFil: Manteca Acosta, Mariana. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Dirección Nacional de Instituto de Investigación. Administración Nacional de Laboratorio e Instituto de Salud "Dr. C. G. Malbrán"; ArgentinaFil: Saux, Maria Cecilia. Universidad Nacional de Jose Clemente Paz; ArgentinaFil: Rivero, Rocío. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Dirección Nacional de Instituto de Investigación. Administración Nacional de Laboratorio e Instituto de Salud "Dr. C. G. Malbrán"; Argentina. Universidad Nacional de Jose Clemente Paz; ArgentinaFil: Soratti, Mariano. Universidad Nacional de Jose Clemente Paz; ArgentinaFil: Marsico, Franco Leonel. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad Nacional de Jose Clemente Paz; ArgentinaFil: Lopez, Maria Noelia. Universidad Nacional de Jose Clemente Paz; ArgentinaFil: Pazos, Jonhatan. Universidad Nacional de Jose Clemente Paz; Argentin

Gubernamentalidad sanitaria poscovid: Tecnologías para el control, monitoreo y vigilancia de la salud en el municipio de José C. Paz

La pandemia de COVID-19 ha causado una disrupción global en la sociedad y particularmente en sus sistemas de atención médica. A raíz de esto, el uso de la tecnología se aceleró a un ritmo vertiginoso. Las tecnologías sanitarias (TS) se expresan en un conjunto bastante heterogéneo de dispositivos que abarcan desde apps, líneas telefónicas, consultas por videoconferencias, chatbots, recetas electrónicas, resultados de exámenes a través de la red, entre otros. En el campo de la salud, las TS se habían empezado a implementar mundialmente, pero la rápida propagación del SARS-COV-2 ha proporcionado la oportunidad para adoptar plenamente su uso como políticas públicas en el diagnóstico, seguimiento, prevención, cuidado y vigilancia de la salud. En Argentina la pandemia de COVID-19 generó un nuevo portafolio de políticas públicas intersectoriales e interjurisdiccionales modificando las estrategias gubernamentales de todo el país durante el 2020 y el 2021. Las soluciones para administrar la pandemia instalaron a la salud como bien público prioritario e impulsó la reorganización de la gestión de los recursos públicos y privados para la atención sanitaria, independiente de la propia organización y fragmentación característicos de nuestro sistema sanitario. Particularmente, la provincia de Buenos Aires desplegó un conjunto de tecnologías sanitarias (TS) para coordinar la gestión integral del sistema de salud e impulsar una nueva gobernabilidad en ese campo. Las TS ayudaron a construir mecanismos de coordinación y cooperación intersectorial e interjurisdiccional que facilitaron la prevención, el cuidado y el seguimiento de la salud de millones de ciudadanos bonaerenses. Este artículo presenta los resultados de una evaluación del proceso de implementación de las TS, particularmente de la línea telefónica 148, tomando la información cuantitativa georreferenciada y disponible del Ministerio de Salud de la Provincia de Buenos Aires, particularmente del Municipio de José C. Paz, durante los años 2020 y 2021.Fil: Belardo, Marcela Beatriz. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad Nacional de Jose Clemente Paz. Instituto de Estudios Sociales En Contextos de Desigualdades.; ArgentinaFil: Manteca Acosta, Mariana. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Dirección Nacional de Instituto de Investigación. Administración Nacional de Laboratorio e Instituto de Salud "Dr. C. G. Malbrán"; ArgentinaFil: Saux, Maria Cecilia. Universidad Nacional de Jose Clemente Paz; ArgentinaFil: Rivero, Rocío. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Dirección Nacional de Instituto de Investigación. Administración Nacional de Laboratorio e Instituto de Salud "Dr. C. G. Malbrán"; Argentina. Universidad Nacional de Jose Clemente Paz; ArgentinaFil: Soratti, Mariano. Universidad Nacional de Jose Clemente Paz; ArgentinaFil: Marsico, Franco Leonel. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad Nacional de Jose Clemente Paz; ArgentinaFil: Lopez, Maria Noelia. Universidad Nacional de Jose Clemente Paz; ArgentinaFil: Pazos, Jonhatan. Universidad Nacional de Jose Clemente Paz; Argentin

Effectiveness of the first component of Gam-COVID-Vac (Sputnik V) on reduction of SARS-CoV-2 confirmed infections, hospitalisations and mortality in patients aged 60-79: a retrospective cohort study in Argentina

Background A first-dose of various vaccines provides acceptable protection against infections by SARS-CoV-2 and evolution to the most severe forms of COVID-19. The recombinant adenovirus (rAd)-based vaccine, Gam-COVID-Vac (Sputnik V), was proven efficacious but information about effectiveness in the real-world setting is lacking. The aim of our study was to investigate the association between the rollout of the first component (rAd26) of Gam-COVID-Vac and PCR-positive tests, hospitalisations and deaths. Methods We conducted a retrospective cohort study which analyzed individuals aged 60-79 who self-registered in the online vaccination system of the Province of Buenos Aires, Argentina, from December 29, 2020 to March 21, 2021. Exclusion criteria were having a previous positive RT-PCR or antigen tests for SARS-CoV-2, having received other vaccines, or two doses of any vaccine. Proportions of new laboratory-confirmed SARS-CoV-2 infections, hospitalisations and deaths until 83 days of vaccination were compared between vaccinated and unvaccinated subjects. Vaccine effectiveness for the three outcomes was calculated as (1–OR) × 100. Kaplan-Meier cumulative incidence curves were constructed. Findings During the study period 415995 registered subjects received the first component of Gam-COVID-Vac; 40387 belonged to the 60-79 age group, and were compared to 38978 unvaccinated. Vaccine effectiveness for preventing laboratory-confirmed infections was 78•6% [CI95% 74·8 - 81·7]; and for reducing hospitalizations and deaths was, respectively, 87·6% [CI95% 80·3 - 92·2] and 84·8% [CI95% 75·0 - 90·7]. Effectiveness was high across all subgroups. Interpretation Similarly to other vaccines, the administration of one dose of Gam-COVID-Vac was effective for a wide range of COVID-19–related outcomes.Facultad de Ciencias Médica

The evaluation of the fibromyalgia patients.

Fibromyalgia (FM) is a rheumatic disease characterized by musculoskeletal pain, chronic diffuse tension and/or stiffness in joints and muscles, easy fatigue, sleep and emotional disturbances, and pressure pain sensitivity in at least 11 of 18 tender points. At present, there are no instrumental tests or specific diagnostic markers for FM; in fact, many of the existing indicators are significant for research purposes only. Many differential diagnoses may be excluded by an extensive clinical examination and patient history. Considering overlap of FM with other medical conditions, the treating physicians should be vigilant: chest-X-rays and abdominal ultrasonography are the first steps of general evaluation for all the patients with suspected FM. Functional neuroimaging methods have revealed a large number of supraspinal effects in FM, a disorder mediated by mechanisms that are essentially unknown. Many treatments are used in FM patients, but evaluating their therapeutic effects in FM is difficult because the syndrome is so multifaceted. To address the identification of core outcome domains, the Initiative on IMMPACT and OMERACT workshop convened a meeting to develop consensus recommendations for chronic pain clinical trials

Fibromyalgia syndrome : definition and diagnostic aspects

Ever since it was first defined, fibromyalgia (FM) has been considered one of the most controversial diagnoses in the field of rheumatology, to the point that not everybody accepts its existence as an independent entity. The sensitivity and specificity of the proposed diagnostic criteria are still debated by various specialists (not only rheumatologists), whose main criticism of the 1990 American College of Rheumatology criteria is that they identify subsets of particular patients that do not reflect everyday clinical reality. Furthermore, the symptoms characterising FM overlap with those of many other conditions classified in a different manner. Over the last few years, this has led to FM being considered less as a clinical entity and more as a possible manifestation of alterations in the psychoneuroendocrine system (the spectrum of affective disorders) or the stress reaction system (dysfunctional symptoms). More recently, doubts have been raised about even these classifications; and it now seems more appropriate to include FM among the central sensitisation syndromes, which identify the main pathogenetic mechanism as the cause of skeletal and extra-skeletal symptoms of FM and other previously defined "dysfunctional" syndromes

Non pharmacological treatments in fibromyalgia

Fibromyalgia is a complex syndrome associated with significant impairment in quality of life and function and with substantial financial costs. Once the diagnosis is made, providers should aim to increase patients' function and minimize pain. Fibromyalgia patients frequently use alternative therapies, strongly indicating both their dissatisfaction with and the substantial ineffectiveness of traditional medical therapy, especially pharmacological treatments. At present, pharmacological treatments for fibromyalgia have a rather discouraging cost/benefit ratio in terms of poor symptom control and high incidence of side effects. The interdisciplinary treatment programs have been shown to improve subjective pain with greater success than monotherapy. Physical therapies, rehabilitation and alternative therapies are generally perceived to be more "natural," to have fewer adverse effects, and in some way, to be more effective. In this review, physical exercise and multimodal cognitive behavioural therapy are presented as the more accepted and beneficial forms of nonpharmacological therapy