Bio-Radar Applications for Remote Vital Signs Monitoring

Nowadays, most vital signs monitoring techniques used in a medical context and/or daily life routines require direct contact with skin, which can become uncomfortable or even impractical to be used regularly. Radar technology has been appointed as one of the most promising contactless tools to overcome these hurdles. However, there is a lack of studies that cover a comprehensive assessment of this technology when applied in real-world environments. This dissertation aims to study radar technology for remote vital signs monitoring, more specifically, in respiratory and heartbeat sensing. Two off-the-shelf radars, based on impulse radio ultra-wideband and frequency modu lated continuous wave technology, were customized to be used in a small proof of concept experiment with 10 healthy participants. Each subject was monitored with both radars at three different distances for two distinct conditions: breathing and voluntary apnea. Signals processing algorithms were developed to detect and estimate respiratory and heartbeat parameters, assessed using qualitative and quantitative methods. Concerning respiration, a minimum error of 1.6% was found when radar respiratory peaks signals were directly compared with their reference, whereas a minimum mean absolute error of 0.3 RPM was obtained for the respiration rate. Concerning heartbeats, their expression in radar signals was not as clear as the respiration ones, however a minimum mean absolute error of 1.8 BPM for heartbeat was achieved after applying a novel selective algorithm developed to validate if heart rate value was estimated with reliability. The results proved the potential for radars to be used in respiratory and heartbeat contactless sensing, showing that the employed methods can be already used in some mo tionless situations. Notwithstanding, further work is required to improve the developed algorithms in order to obtain more robust and accurate systems.Atualmente, a maioria das técnicas usadas para a monitorização de sinais vitais em contexto médicos e/ou diário requer contacto direto com a pele, o que poderá tornar-se incómodo ou até mesmo inviável em certas situações. A tecnologia radar tem vindo a ser apontada como uma das mais promissoras ferramentas para medição de sinais vitais à distância e sem contacto. Todavia, são necessários mais estudos que permitam avaliar esta tecnologia quando aplicada a situações mais reais. Esta dissertação tem como objetivo o estudo da tecnologia radar aplicada no contexto de medição remota de sinais vitais, mais concretamente, na medição de atividade respiratória e cardíaca. Dois aparelhos radar, baseados em tecnologia banda ultra larga por rádio de impulso e em tecnologia de onda continua modulada por frequência, foram configurados e usados numa prova de conceito com 10 participantes. Cada sujeito foi monitorizado com cada um dos radar em duas situações distintas: respirando e em apneia voluntária. Algorit mos de processamento de sinal foram desenvolvidos para detetar e estimar parâmetros respiratórios e cardíacos, avaliados através de métodos qualitativos e quantitativos. Em relação à respiração, o menor erro obtido foi de 1,6% quando os sinais de radar respiratórios foram comparados diretamente com os sinais de referência, enquanto que, um erro médio absoluto mínimo de 0,3 RPM foi obtido para a estimação da frequência respiratória via radar. A expressão cardíaca nos sinais radar não se revelou tão evidente como a respiratória, no entanto, um erro médio absoluto mínimo de 1,8 BPM foi obtido para a estimação da frequência cardíaca após a aplicação de um novo algoritmo seletivo, desenvolvido para validar a confiança dos valores obtidos. Os resultados obtidos provaram o potencial do uso de radares na medição de atividade respiratória e cardíaca sem contacto, sendo esta tecnologia viável de ser implementada em situações onde não existe muito movimento. Não obstante, os algoritmos desenvolvidos devem ser aperfeiçoados no futuro de forma a obter sistemas mais robustos e precisos

Cleaning in times of pandemic: perceptions of COVID-19 risks among workers in facility

Cleaning services are a transversal activity that guarantees the proper functioning and conditions of safety, hygiene, and health across all economic sectors. The COVID-19 pandemic increased the need for clean, sanitary spaces, particularly in health services and other areas with a large number of people. The workers in these services were often placed on the frontline without any specific training or information. Their low average schooling aggravated this situation. Therefore, exploring these workers perceptions about the COVID-19 pandemic and its potential influence on their mental health was the primary goal of our research. Structured interviews were conducted based on questionnaires in a sample of 436 women. Their characterisation focused on three aspects related to the pandemic. First, to prevent infecting others (85.5%) and that people close to them could die (86.0%) were the dominant concerns; second, the feeling of permanent vigilance was mentioned (56.2%); and third, the fear of not getting medical care (60.7%). Thus, the workers felt there was a need for more dissemination of individual protection measures, as well as more training, better general working conditions, and access to psychological counselling

Cleaning in times of pandemic

Cleaning services are a transversal activity that guarantees the proper functioning and conditions of safety, hygiene, and health across all economic sectors. The COVID-19 pandemic increased the need for clean, sanitary spaces, particularly in health services and other areas with a large number of people. The workers in these services were often placed on the frontline without any specific training or information

Height and body-mass index trajectories of school-aged children and adolescents from 1985 to 2019 in 200 countries and territories: a pooled analysis of 2181 population-based studies with 65 million participants

Summary Background Comparable global data on health and nutrition of school-aged children and adolescents are scarce. We aimed to estimate age trajectories and time trends in mean height and mean body-mass index (BMI), which measures weight gain beyond what is expected from height gain, for school-aged children and adolescents. Methods For this pooled analysis, we used a database of cardiometabolic risk factors collated by the Non-Communicable Disease Risk Factor Collaboration. We applied a Bayesian hierarchical model to estimate trends from 1985 to 2019 in mean height and mean BMI in 1-year age groups for ages 5–19 years. The model allowed for non-linear changes over time in mean height and mean BMI and for non-linear changes with age of children and adolescents, including periods of rapid growth during adolescence. Findings We pooled data from 2181 population-based studies, with measurements of height and weight in 65 million participants in 200 countries and territories. In 2019, we estimated a difference of 20 cm or higher in mean height of 19-year-old adolescents between countries with the tallest populations (the Netherlands, Montenegro, Estonia, and Bosnia and Herzegovina for boys; and the Netherlands, Montenegro, Denmark, and Iceland for girls) and those with the shortest populations (Timor-Leste, Laos, Solomon Islands, and Papua New Guinea for boys; and Guatemala, Bangladesh, Nepal, and Timor-Leste for girls). In the same year, the difference between the highest mean BMI (in Pacific island countries, Kuwait, Bahrain, The Bahamas, Chile, the USA, and New Zealand for both boys and girls and in South Africa for girls) and lowest mean BMI (in India, Bangladesh, Timor-Leste, Ethiopia, and Chad for boys and girls; and in Japan and Romania for girls) was approximately 9–10 kg/m2. In some countries, children aged 5 years started with healthier height or BMI than the global median and, in some cases, as healthy as the best performing countries, but they became progressively less healthy compared with their comparators as they grew older by not growing as tall (eg, boys in Austria and Barbados, and girls in Belgium and Puerto Rico) or gaining too much weight for their height (eg, girls and boys in Kuwait, Bahrain, Fiji, Jamaica, and Mexico; and girls in South Africa and New Zealand). In other countries, growing children overtook the height of their comparators (eg, Latvia, Czech Republic, Morocco, and Iran) or curbed their weight gain (eg, Italy, France, and Croatia) in late childhood and adolescence. When changes in both height and BMI were considered, girls in South Korea, Vietnam, Saudi Arabia, Turkey, and some central Asian countries (eg, Armenia and Azerbaijan), and boys in central and western Europe (eg, Portugal, Denmark, Poland, and Montenegro) had the healthiest changes in anthropometric status over the past 3·5 decades because, compared with children and adolescents in other countries, they had a much larger gain in height than they did in BMI. The unhealthiest changes—gaining too little height, too much weight for their height compared with children in other countries, or both—occurred in many countries in sub-Saharan Africa, New Zealand, and the USA for boys and girls; in Malaysia and some Pacific island nations for boys; and in Mexico for girls. Interpretation The height and BMI trajectories over age and time of school-aged children and adolescents are highly variable across countries, which indicates heterogeneous nutritional quality and lifelong health advantages and risks

Rising rural body-mass index is the main driver of the global obesity epidemic in adults

Body-mass index (BMI) has increased steadily in most countries in parallel with a rise in the proportion of the population who live in cities(.)(1,2) This has led to a widely reported view that urbanization is one of the most important drivers of the global rise in obesity(3-6). Here we use 2,009 population-based studies, with measurements of height and weight in more than 112 million adults, to report national, regional and global trends in mean BMI segregated by place of residence (a rural or urban area) from 1985 to 2017. We show that, contrary to the dominant paradigm, more than 55% of the global rise in mean BMI from 1985 to 2017-and more than 80% in some low- and middle-income regions-was due to increases in BMI in rural areas. This large contribution stems from the fact that, with the exception of women in sub-Saharan Africa, BMI is increasing at the same rate or faster in rural areas than in cities in low- and middle-income regions. These trends have in turn resulted in a closing-and in some countries reversal-of the gap in BMI between urban and rural areas in low- and middle-income countries, especially for women. In high-income and industrialized countries, we noted a persistently higher rural BMI, especially for women. There is an urgent need for an integrated approach to rural nutrition that enhances financial and physical access to healthy foods, to avoid replacing the rural undernutrition disadvantage in poor countries with a more general malnutrition disadvantage that entails excessive consumption of low-quality calories.Peer reviewe

COVID-19 symptoms at hospital admission vary with age and sex: results from the ISARIC prospective multinational observational study

Background: The ISARIC prospective multinational observational study is the largest cohort of hospitalized patients with COVID-19. We present relationships of age, sex, and nationality to presenting symptoms. Methods: International, prospective observational study of 60 109 hospitalized symptomatic patients with laboratory-confirmed COVID-19 recruited from 43 countries between 30 January and 3 August 2020. Logistic regression was performed to evaluate relationships of age and sex to published COVID-19 case definitions and the most commonly reported symptoms. Results: ‘Typical’ symptoms of fever (69%), cough (68%) and shortness of breath (66%) were the most commonly reported. 92% of patients experienced at least one of these. Prevalence of typical symptoms was greatest in 30- to 60-year-olds (respectively 80, 79, 69%; at least one 95%). They were reported less frequently in children (≤ 18 years: 69, 48, 23; 85%), older adults (≥ 70 years: 61, 62, 65; 90%), and women (66, 66, 64; 90%; vs. men 71, 70, 67; 93%, each P < 0.001). The most common atypical presentations under 60 years of age were nausea and vomiting and abdominal pain, and over 60 years was confusion. Regression models showed significant differences in symptoms with sex, age and country. Interpretation: This international collaboration has allowed us to report reliable symptom data from the largest cohort of patients admitted to hospital with COVID-19. Adults over 60 and children admitted to hospital with COVID-19 are less likely to present with typical symptoms. Nausea and vomiting are common atypical presentations under 30 years. Confusion is a frequent atypical presentation of COVID-19 in adults over 60 years. Women are less likely to experience typical symptoms than men

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030