Efektivitas Adaptasi Teknologi pada Kinerja Sistem Surveilans Malaria di Era COVID-19 untuk Negara Berkembang: Sebuah Kajian Sistematis

Abstract—Due to the limitations of the current malaria surveillance system, the use of technology for diagnostics and treatment is an important factor in controlling the number of malaria cases at local and national levels. However, studies on the effectiveness of the implementation of technology-assisted surveillance systems have yet to be found. The literature search was conducted based on the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA). This systematic review was conducted using PubMed, Scopus, ScienceDirect, Cochrane, Google Scholar, and EBSCOHost databases. Assessment of study bias and methodology was carried out with the National Institutes of Health (NIH) Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. The literature search yielded 9 literatures with a total subject of 322,168. The usage of technology in malaria surveillance system has been shown to shorten the time of discovery, reporting, case follow-up response. The interventions also improve the completeness and accuracy of the data and improve user-supervisor coordination while also receiving  positive responses from the users. This study demonstrates the effectiveness of implementing a technology-based malaria surveillance system in developing countries in the COVID-19 era. Further research with larger and uniform population is needed to strengthen the evidence for successful implementations. Keyword: malaria, surveillance, mobile health, low resource countries, covid-19 Abstrak—Mengingat keterbatasan sistem surveilans malaria yang ada saat ini, penggunaan teknologi dalam melakukan pelaporan diagnostik maupun pengobatan kasus merupakan faktor penting dalam menentukan pengendalian jumlah kasus malaria pada tingkat lokal dan nasional. Namun, kajian mengenai efektivitas penggunaanya masih belum dapat ditemukan. Pencarian literatur studi dilakukan berdasarkan the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA). Kajian sistematis ini dilakukan melalui database dan. Penilaian bias dan metodologi studi dilakukan dengan National Institutes of Health (NIH) Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Pencarian literatur menghasilkan 9 literatur dengan total subjek 322.168 orang. Penggunaan teknologi dalam sistem surveilans malaria terbukti mempersingkat waktu penemuan, waktu pelaporan, hingga waktu respon follow-up kasus. Selain meningkatkan kelengkapan dan keakuratan data, teknologi tersebut juga membantu koordinasi pengguna dengan supervisor dan mendapatkan respon positif dari pengguna. Kajian sistematik ini menunjukkan efektivitas penerapan sistem surveilans malaria berbasis teknologi pada negara berkembang di era COVID-19. Penelitian lanjut dengan populasi yang besar dan seragam dibutuhkan untuk memperkuat bukti kesuksesan penerapan. Kata Kunci: malaria, surveilans, mobile health, negara sumber daya rendah, covid-1

Differences in treatment and clinical outcomes in patients aged ≥75 years compared with those aged ≤74 years following acute coronary syndromes: a prospective multicentre study

Objective This study describes the differences in treatment and clinical outcomes in patients aged ≥75 years compared with those aged ≤74 years presenting with acute coronary syndrome (ACS) and undergoing invasive management.Methods A large-scale cohort study of patients with ST-elevation/non-ST-elevation myocardial infarction (MI)/unstable angina underwent coronary angiography (January 2015–December 2019). Patients were classified as older (≥75 years) and younger (≤74 years). Regression analysis was used to yield adjusted risks of mortality for older versus younger patients (adjusted for history of heart failure, hypercholesterolaemia, peripheral vascular disease, chronic obstructive pulmonary disease, ischaemic heart disease, presence of ST-elevation MI on presenting ECG, female sex and cardiogenic shock at presentation).Results In total, 11 763 patients were diagnosed with ACS, of which 39% were aged ≥75 years. Percutaneous coronary intervention was performed in fewer older patients than younger patients (81.2% vs 86.2%, p<0.001). At discharge, older patients were prescribed less secondary-prevention medications than younger patients. Median follow-up was 4.57 years. Older patients had a greater risk of in-hospital mortality than younger patients (adjusted OR (aOR) 2.12, 95% CI 1.62 to 2.78, p<0.001). Older patients diagnosed with ST-elevation MI had greater adjusted odds of dying in-hospital (aOR 2.47, 95% CI 1.79 to 3.41, p<0.001). Older age was not an independent prognostic factor of mortality at 1 year (adjusted HR (aHR) 0.95, 95% CI 0.82 to 1.09, p=0.460) and at longer term (aHR 0.98, 95% CI 0.87 to 1.10, p=0.684).Conclusions Older patients are discharged with less secondary prevention. Patients aged ≥75 years are more likely to die in-hospital than younger patients

Cognitive impairment and outcomes in older adults with non-ST-elevation acute coronary syndrome

Objective This study aimed to explore the prognostic impact of cognitive impairment on the long-term risk of major adverse cardiovascular events (MACEs) in older patients with non-ST-elevation acute coronary syndrome (NSTEACS) undergoing invasive treatment.Methods Patients aged >= 75 years with NSTEACS undergoing an invasive strategy were included in the multicentre prospective study (NCT01933581). Montreal Cognitive Assessment was used to evaluate cognitive status at baseline (scores >= 26 classified as normal, <26 as cognitive impairment). Long-term follow-up data were obtained from electronic patient care records. The primary endpoint was MACE as a composite of all-cause deaths, reinfarction, stroke/transient ischaemic attack, urgent revascularisation and significant bleeding.Results 239 patients with baseline cognitive assessment completed long-term follow-up. Median age was 80.9 years (IQR 78.2-83.9 years) and 62.3% were male. On 5-year follow-up, there was no significant difference in the occurrence of MACE between the cognitively impaired group and the normal cognition group (p=0.155). Cognition status was not associated with MACE (HR 1.37 (95% CI 0.96 to 1.95); p=0.082). However, there was significantly more deaths (p=0.005) in those with cognitive impairment. Kaplan-Meier survival analysis (log-rank p=0.003) and Cox regression analysis (aHR 1.85 (95% CI 1.11 to 3.08); p=0.018) revealed increased risk of all-cause mortality, even after adjusting for frailty and GRACE (Global Registry of Acute Coronary Events) score.Conclusion Cognitive impairment in older patients with NSTEACS undergoing an invasive strategy was associated with long-term all-cause mortality. Routine cognitive screening may aid risk stratification and further studies are needed to identify how this should influence management strategies and individual decision-making in this patient group

Mental health disturbance in preclinical medical students and its association with screen time, sleep quality, and depression during the COVID-19 pandemic

Abstract Background Affected by various hurdles during COVID-19, preclinical medical students are at an elevated risk for mental health disturbances. However, the effects of modern mental health problems on preclinical medical students have not been adequately researched. Thus, this study was aimed to identify the proportions and implications of current mental health problems for depression, sleep quality and screen time among Indonesian medical preclinical students during the COVID-19 pandemic. Methods This cross-sectional study was conducted using crowdsourcing between October 2020 and June 2021. During the study period, 1,335 subjects were recruited, and 1,023 datasets were identified as valid. General Health Questionnaire-12 (GHQ-12) was used to measure current mental health disturbances (categorized as without current mental health disturbances, psychological distress, social dysfunction, or both). The Patient Health Questionnaire-9 (PHQ-9) was used to assess depression, the Pittsburgh Sleep Quality Index (PSQI) was employed to assess sleep quality, and a questionnaire devised for this study was used to assess screen time length per day. Multivariate data analysis was conducted using SPSS version 24 for Mac. Results According to the findings, 49.1% of the 1,023 participants had current mental health disturbances: 12.8% had psychological distress, 15.9% had social dysfunction, and the rest (20.4%) had both psychological distress and social dysfunction. The statistical analysis provided strong evidence of a difference (p < 0.001) between the medians of depression and sleep quality with at least one pair of current mental health disturbance groups, but the difference for screen time was not significant (p = 0.151). Dunn’s post-hoc analysis showed that groups without current mental health problems had significantly lower mean ranks of depression and sleep quality compared to groups that had current mental health problems (p < 0.001). Conclusion Current mental health disturbances during the COVID-19 pandemic were significantly associated with preclinical medical students’ depression and sleep quality in preclinical medical students. Thus, mental health programs for this specific population should be tailored to integrate mindfulness therapy, support groups, stress management, and skills training to promote mental wellbeing