Comparison of european health related ICT projects

Introdução: No mundo globalizado dos nossos dias, é expectável que os profissionais de saúde prestem os seus serviços a pacientes estrangeiros nalgum ponto das suas carreiras. A diferença de idiomas, sistemas de saúde e infraestruturas são barreiras para uma prestação de cuidados semelhantes aos que os cidadãos conhecem nos seus países de origem. Novas soluções interoperáveis para a partilha de informação clínica a níveis transfronteiriços figuram, por isso, na lista das prioridades digitais da agenda política dos Estados-Membros da União Europeia (UE) (1). A adoção da Diretiva 2011/24/UE do Parlamento Europeu e do Conselho, de Março de 2011, sobre os Direitos dos Pacientes nos cuidados de saúde transfronteiriços, representa o auge da liberdade dos cidadãos para receberem cuidados de saúde noutros Estados-Membros da União Europeia, com qualidade e segurança (2). Com o objetivo de facilitar ‘a prestação de serviços públicos Europeus, promovendo a interoperabilidade transfronteiriça e inter-sectorial’ (7), a European Interoperability Framework (EIF) estabelece uma série de recomendações que promovem várias políticas e iniciativas na UE, ao mesmo tempo que define quatro dimensões para a interoperabilidade: legal, organizacional, semântica e técnica. Objetivo: O objetivo do presente estudo é abordar o desafio da transição de soluções-piloto para uma infraestrutura transfronteiriça de larga-escala, que apoie os Estados-Membros da União Europeia na prestação de serviços públicos, especialmente no setor de saúde. Metodologias: Esta revisão aborda, empiricamente, informação publicada e não-publicada sobre eHealth e sistemas de partilha de dados clínicos, resumindo e correlacionando as conclusões mais importantes de diferentes fontes. É particularmente centrada na análise transversal de quatro projetos Europeus: epSOS, eSENS, Trillium Bridge e EXPAND. Resultados: As Diretivas de Proteção de Dados 95/46/CE e dos Direitos dos Pacientes nos cuidados de saúde transfronteiriços 2011/24/UE são os principais instrumentos legais abordados em todas as iniciativas, não obstante da existência de legislações nacionais. Métodos de trabalho estabelecidos no âmbito das organizações de saúde necessitam de ser adaptados e otimizados, de acordo com as novas arquiteturas de comunicação, mas serão os usuários os principais responsáveis pela sua integração nos seus próprios sistemas, procedimentos e culturas de trabalho. A interpretação universal de dados em saúde pode ser alcançada com terminologias mutuamente aceites, sistemas de codificação e criação de meta-informação, como o mapeamento da Health Level Seven Release 2 (HL 7 R2). O padrão de comunicação Clinical Document Architecture (CDA) estabelece uma estrutura consistente entre sistemas de informação clínica utilizados na Europa. Conclusões: Ainda existem inúmeras barreiras para uma prestação transeuropeia eficaz de serviços públicos. Apesar de um certo nível de complexidade que ainda marca os sistemas de informação em saúde, são várias as vantagens da sua utilização: o acesso rápido e seguro a dados de saúde relevantes para as decisões clínicas, confidencialidade dos mesmos, centralização e organização de acordo com classificações médicas internacionais, bem como a promoção de controlo estatístico e otimização de desempenho (12). A interoperabilidade não é uma finalidade ou uma questão de presença ou ausência, é antes um processo que poderá ser melhorado ao longo do tempo (59). Mais estudos serão necessários para entender como poderemos melhorar os nossos sistemas de informação, para uma partilha sustentável de dados cada vez mais complexos, como a informação em saúde.Introduction: With the globalized world of our days, health professionals are expected to provide their services to foreign patients at some point in their careers. Different languages, health systems and infrastructures are barriers to a sound provision of health care as people have been used to in their home countries. New interoperable solutions for the exchange of clinical data at cross-border levels are now listed as new digital priorities in the political agenda of the European Union (EU) Member States (MS) (1). The adoption of the Directive 2011/24/EU of the European Parliament and the Council of March 2011 on Patient’s Rights in cross-border health care was the pinnacle to assure citizen’s freedom to receive health care in another EU Member State, with quality and safety (2). With the purpose of facilitating ‘the delivery of European public services by fostering cross-border and cross-sectoral interoperability’ (7), the European Interoperability Framework (EIF) establishes a series of recommendations that promote several EU policy initiatives, while defining four dimensions for interoperability: legal, organizational, semantic, and technical. Objective: The purpose of the present review is to address the challenge of stirring from point-solution pilots to a large-scale deployment of cross-border facilities that support EU Member States in delivering public services, especially in health sector. Methodologies: This study empirically addresses published and unpublished information in eHealth and clinical data exchange systems, summarizing and correlating the most important conclusions of different sources. Particularly, it is centered in a transversal analysis of four different European projects focused on providing solutions for cross-border health care services: epSOS, eSENS, Trillium Bridge and EXPAND. Results: The Data Protection Directive 95/46/EC and the Patient’s Rights in cross-border health care Directive 2011/24/EU are the major legal instruments to comply with by all initiatives, notwithstanding the existence of national legislations. Established workflows within heath organizations need to be adapted and optimized according to new communication architectures, but users are ultimately responsible for integrating them in their own systems, procedures and working cultures. A universal interpretation of health data can be achieved with mutually accepted terminologies, coding systems and creation of metadata, such as Health Level Seven Release 2 (HL 7 R2) mapping. The Clinical Document Architecture (CDA) communication standard establishes structure consistency among health IT systems used in Europe. Conclusions: There are still numerous barriers in effective delivery of public services in a pan-European setting. Although a certain level of complexity is still present in health information systems, several advantages can still be highlighted such as rapid and secure access to health data relevant for the decision-making at the care point, confidentiality promotion, centralization and structuring according with medical standards and the promotion of statistical control and performance optimization (12). Interoperability is not an ending or a question of being present or absent, but rather a process that can be improved over time (59). More studies are needed to understand how we can better connect our IT systems towards a sustainable exchange route of richer and even more intricate data, as sensitive as health information

Sexualidade na gravidez

A gestação influencia a função sexual feminina, particularmente, nos domínios do desejo e da excitação, revelando a importância da abordagem do tema pelos profissionais de saúde.info:eu-repo/semantics/publishedVersio

Manipulating the number of players and targets in team sports : small-sided games during physical education classes

This study aimed to examine the effects of players and targets number variation on technical, tactical and physiological indicators in basketball, handball and indoor football. Nine 8th grade students (age 13.3 ± 0.7 years, stature 166.8 ± 3.8 cm, body mass 55.3 ± 4.2 kg) participated in four small-sided games (SSG) for each sport. Despite the differences between the sports, similar average values for technical and tactical indicators were found in both basketball and indoor football SSG. An increase in the number of players affected the duration of unsuccessful offensive phases, the number of passes per offensive phase, successful passes per offensive phase and decreased ball possession per player. Whilst all SSG in this study imposed high physiological demands, 3-a-side games played with one target elicited the greatest responses. In conclusion, the 3-a-side SSG promoted similar technical-tactical indicators and higher physiological demands than 4-a-side SSG.Este estudio tuvo como objetivo examinar los efectos del número de jugadores y metas en la variación de los indicadores técnicos, tácticos y fisiológicos en baloncesto, balonmano y fútbol sala. Nueve estudiantes del octavo grado (edad 13.3 ± 0.7 años, estatura 166.8 ± 3.8 cm, masa corporal 55.3 ± 4.2 kg) participarón en cuatro juegos reducidos (SSG) para cada deporte. A pesar de las diferencias entre los deportes, se encontrarón valores medios similares en los indicadores técnicos y tácticos tanto en los juegos reducidos del baloncesto como en los de fútbol sala. El aumento de los jugadores ha provocado el aumento de la duración de la fase ofensiva sin éxito, número de pases por fase ofensiva, pases acertados por fase ofensiva y ha provocado una disminución de la posesión del balón por jugador. Mientras la totalidad de juegos reducidos utilizados en este estudio han impuesto un elevada demanda fisiológica, los juegos reducidos de 3x3 jugados con una meta provocaron las mayores respuestas. En conclusión, los juegos reducidos de 3x3 ha inducido valores similares en los indicadores técnico-tácticos, pero demandas fisiológicas más altas que los juegos reducidos de 4x4.Este estudo teve como objectivo analisar os efeitos do número de jogadores e dos objectivos na variação dos indicadores técnicos, tácticos e fisiológicos no basquetebol, andebol e futsal. Nove estudantes do oitavo ano (idade 13.3 ± 0.7 anos, estatura 166.8 ± 3.8 cm, massa corporal 55.3 ± 4.2 kg) participaram em quatro jogos reduzidos (SSG) para cada modalidade. Apesar das diferenças entre os desportos, foram verificados valores médios similares nos indicadores técnicos e tácticos nos jogos reduzidos de basquetebol e futsal. O aumento dos jogadores provocou o aumento da duração da fase ofensiva sem êxito, número de passes por fase ofensiva, passes certos por fase ofensiva e provocou uma diminuição da posse de bola por jogador. Enquanto a totalidade de jogos reduzidos utilizados neste estudo implicou uma elevada exigência fisiológica, os jogos reduzidos de 3X3 jogados com um objectivo provocaram as maiores respostas. Em suma, os jogos reduzidos de 3x3 induziram valores similares nos indicadores técnico-tácticos, mas exigências fisiológicas mais elevadas que os jogos reduzidos de 4X4

Design, synthesis and biologival evaluation of novel isoniazid derivatives with potente antitubercular activity

The disturbing emergence of multidrug-resistant strains of Mycobacterium tuberculosis (Mtb) has been driving the scientific community to urgently search for new and efficient antitubercular drugs. Despite the various drugs currently under evaluation, isoniazid is still the key and most effective component in all multi-therapeutic regimens recommended by the WHO. This paper describes the QSAR-oriented design, synthesis and in vitro antitubercular activity of several potent isoniazid derivatives (isonicotinoyl hydrazones and isonicotinoyl hydrazides) against H37Rv and two resistant Mtb strains. QSAR studies entailed RFs and ASNNs classification models, as well as MLR models. Strict validation procedures were used to guarantee the models' robustness and predictive ability. Lipophilicity was shown not to be relevant to explain the activity of these derivatives, whereas shorter N-N distances and lengthy substituents lead to more active compounds. Compounds I, 2, 4, 5 and 6, showed measured activities against H37Rv higher than INH (i.e., MIC <= 0.28 mu M), while compound 9 exhibited a six fold decrease in MIC against the katG (S315T) mutated strain, by comparison with INH (Le., 6.9 vs. 43.8 mu M). All compounds were ineffective against H37Rv(INH) (Delta katG), a strain with a full deletion of the katG gene, thus corroborating the importance of KatG in the activation of INH-based compounds. The most potent compounds were also shown not to be cytotoxic up to a concentration 500 times higher than MIC. (C) 2014 Elsevier Masson SAS. All rights reserved

Characterizing the vaquejada horse herd in the brazilian state of Pernambuco

This study aimed to determine the age groups, breeds, and morphological characteristics of horses used in vaquejada competitions, as well as to define how often the animals compete, the results achieved in the contests, and the duration of training. A sample of 1,271 horses used in vaquejada competitions was employed in the study. The first step consisted in interviewing owners to obtain information on the age and breed of the horses, vaquejada circuits in which they compete, frequency of competition in vaquejada, results reached in the trials, and training duration per month, week, and day. The second step obtained 15 linear measurements and calculated eight morphometric indices. The data obtained from the interviews were submitted to descriptive statistical analyses. The linear measurements and morphometric indices were used to compare sexes using a completely randomized experimental design. The results showed that 80.3% of the vaquejada horses were between four and ten years old and that 89% of the animals were of the Quarter Horse. The morphometric measures showed that stallions had higher height at withers, back, and croup and wider heads, chest, and croup than mares and geldings. On the other hand, among the eight indices calculated, only the value of the height at the chest of the stallions was higher than the mean values in mares and geldings. It was found that 79.7% of the horses took part in two to four vaquejada trials a month while 93.3% of the animals underwent fitness training 12 months a year. The results show a predominance of Quarter Horses in the vaquejada contests in Pernambuco and that the trials require the selection of physically larger and stronger stallions. In addition, the animals are submitted to intense training and competition routines

Prospective Study of Loss of Health-Related Quality Adjusted Life Years in Children and their Families due to Uncomplicated and Hospitalised Varicella

Introduction and aims: Although usually benign, varicella can lead to serious complications and sometimes long-term sequelae. Vaccines are safe and effective but not yet included in immunisation programmes in many countries. We aimed to quantify the impact on health-related quality of life (HRQoL) in terms of quality-adjusted life years (QALY) in children with varicella and their families, key to assessing cost-utility in countries with low mortality due to this infection. Methods: Children with varicella in the community and admitted to hospitals in Portugal were included over 18 months from January 2019. Children's and carers' HRQoL losses were assessed prospectively using standard multi-attribute utility instruments for measuring HRQoL (EQ-5D and CHU9D), from presentation to recovery, allowing the calculation of QALYs. Results: Among 109 families with children with varicella recruited from attendees at a pediatric emergency service (community arm), the mean HRQoL loss/child was 2.0 days (95 % CI 1.9-2.2, n = 101) (mean 5.4 QALYs/1000 children (95 % CI 5.3-6.1) and 1.3 days/primary carer (95 % CI 1.2-1.6, n = 103) (mean 3.6 QALYs /1000 carers (95 % CI 3.4-4.4). Among 114 families with children admitted to hospital because of severe varicella or a complication (hospital arm), the mean HRQoL loss/child was 9.8 days (95 % CI 9.4-10.6, n = 114) (mean 26.8 QALYs /1000 children (95 % CI 25.8-29.0) and 8.5 days/primary carer (95 % CI 7.4-9.6, n = 114) (mean 23.4 QALYs/1000 carers (95 % CI 20.3-26.2). Mean QALY losses/1000 patients were particularly high for bone and joint infections [67.5 (95 % CI 43.9-97.6)]. Estimates for children's QALYs lost using the CHU9D tool were well correlated with those obtained using EQ-5D, but substantially lower. Conclusions: The impact of varicella on HRQoL is substantial. We report the first measurements of QALYs lost in hospitalised children and in the families of children both in the community and admitted to hospital, providing important information to guide vaccination policy recommendations.info:eu-repo/semantics/publishedVersio

Predictors of cardiac involvement in idiopathic inflammatory myopathies

Copyright © 2023 Bandeira, Dourado, Melo, Martins, Fraga, Ferraro, Saraiva, Sousa, Parente, Soares, Correia, Almeida, Dinis, Pinto, Oliveira Pinheiro, Rato, Beirão, Samões, Santos, Mazeda, Chícharo, Faria, Neto, Lourenço, Brites, Rodrigues, Silva-Dinis, Dias, Araújo, Martins, Couto, Valido, Santos, Barreira, Fonseca and Campanilho-Marques. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.Objectives: Idiopathic inflammatory myopathies (IIM) are a group of rare disorders that can affect the heart. This work aimed to find predictors of cardiac involvement in IIM. Methods: Multicenter, open cohort study, including patients registered in the IIM module of the Rheumatic Diseases Portuguese Register (Reuma.pt/Myositis) until January 2022. Patients without cardiac involvement information were excluded. Myo(peri)carditis, dilated cardiomyopathy, conduction abnormalities, and/or premature coronary artery disease were considered. Results: 230 patients were included, 163 (70.9%) of whom were females. Thirteen patients (5.7%) had cardiac involvement. Compared with IIM patients without cardiac involvement, these patients had a lower bilateral manual muscle testing score (MMT) at the peak of muscle weakness [108.0 ± 55.0 vs 147.5 ± 22.0, p=0.008] and more frequently had oesophageal [6/12 (50.0%) vs 33/207 (15.9%), p=0.009] and lung [10/13 (76.9%) vs 68/216 (31.5%), p=0.001] involvements. Anti-SRP antibodies were more commonly identified in patients with cardiac involvement [3/11 (27.3%) vs 9/174 (5.2%), p=0.026]. In the multivariate analysis, positivity for anti-SRP antibodies (OR 104.3, 95% CI: 2.5-4277.8, p=0.014) was a predictor of cardiac involvement, regardless of sex, ethnicity, age at diagnosis, and lung involvement. Sensitivity analysis confirmed these results. Conclusion: Anti-SRP antibodies were predictors of cardiac involvement in our cohort of IIM patients, irrespective of demographical characteristics and lung involvement. We suggest considering frequent screening for heart involvement in anti-SRP-positive IIM patients.info:eu-repo/semantics/publishedVersio

Efeitos do tipo de instalação no conforto térmico de equinos criados no Sertão Pernambucano

Objetivou-se comparar o conforto térmico proporcionado por três diferentes tipos de instalações para equinos criados no Sertão Pernambucano. Foram utilizados 18 equinos adultos, distribuídos aleatoriamente em três tipos de baias ou cercados. O delineamento experimental foi inteiramente ao acaso em esquema de parcelas subsubdivididas, sendo as parcelas compostas por três instalações (baias de alvenaria, cercados sombreados por árvores, cercados cobertos com telhado de fibrocimento). As subparcelas foram constituídas por nove semanas de monitoramento e as subsubparcelas formadas pelos três dias de avaliação em cada semana. As variáveis ambientais utilizadas foram temperatura ambiente, umidade relativa do ar e índice de temperatura e umidade (ITU); e como variáveis fisiológicas as frequências cardíaca e respiratória, temperatura retal e taxa de sudorese dos equinos. Nas três semanas em que se registrou as maiores temperaturas ambiente, em duas delas as temperaturas foram menores nos cercados sombreados por árvores. Já nas quatro semanas em que o ITU variou entre as instalações, os valores calculados para os cercados sombreados por árvores foram inferiores aos obtidos para as baias de alvenaria. Além disso, em seis das nove semanas de monitoramento os valores da frequência cardíaca dos equinos alojados nos cercados foram inferiores aos dos animais mantidos nas baias de alvenaria. Durante as nove semanas de monitoramento os equinos alojados nos cercados sombreados por árvores apresentaram menores temperaturas retais que os animais mantidos nas baias de alvenaria. Concluiu-se que os cercados sombreados por árvores promovem maior conforto térmico e, consequentemente, bem-estar aos equinos criados no sertão pernambucano

Improving Decision-Making for Population Health in Nonhealth Sectors in Urban Environments: the Example of the Transportation Sector in Three Megacities—the 3-D Commission.

Noncommunicable diseases (NCDs) represent a significant global public health burden. As more countries experience both epidemiologic transition and increasing urbanization, it is clear that we need approaches to mitigate the growing burden of NCDs. Large and growing urban environments play an important role in shaping risk factors that influence NCDs, pointing to the ineluctable need to engage sectors beyond the health sector in these settings if we are to improve health. By way of one example, the transportation sector plays a critical role in building and sustaining health outcomes in urban environments in general and in megacities in particular. We conducted a qualitative comparative case study design. We compared Bus Rapid Transit (BRT) policies in 3 megacities-Lagos (Africa), Bogotá (South America), and Beijing (Asia). We examined the extent to which data on the social determinants of health, equity considerations, and multisectoral approaches were incorporated into local politics and the decision-making processes surrounding BRT. We found that all three megacities paid inadequate attention to health in their agenda-setting, despite having considerable healthy transportation policies in principle. BRT system policies have the opportunity to improve lifestyle choices for NCDs through a focus on safe, affordable, and effective forms of transportation. There are opportunities to improve decision-making for health by involving more available data for health, building on existing infrastructures, building stronger political leadership and commitments, and establishing formal frameworks to improve multisectoral collaborations within megacities. Future research will benefit from addressing the political and bureaucratic processes of using health data when designing public transportation services, the political and social obstacles involved, and the cross-national lessons that can be learned from other megacities

Integrating Social Determinants in Decision-Making Processes for Health: Insights from Conceptual Frameworks—the 3-D Commission.

The inclusion of social determinants of health offers a more comprehensive lens to fully appreciate and effectively address health. However, decision-makers across sectors still struggle to appropriately recognise and act upon these determinants, as illustrated by the ongoing COVID-19 pandemic. Consequently, improving the health of populations remains challenging. This paper seeks to draw insights from the literature to better understand decision-making processes affecting health and the potential to integrate data on social determinants. We summarised commonly cited conceptual approaches across all stages of the policy process, from agenda-setting to evaluation. Nine conceptual approaches were identified, including two frameworks, two models and five theories. From across the selected literature, it became clear that the context, the actors and the type of the health issue are critical variables in decision-making for health, a process that by nature is a dynamic and adaptable one. The majority of these conceptual approaches implicitly suggest a possible role for data on social determinants of health in decision-making. We suggest two main avenues to make the link more explicit: the use of data in giving health problems the appropriate visibility and credibility they require and the use of social determinants of health as a broader framing to more effectively attract the attention of a diverse group of decision-makers with the power to allocate resources. Social determinants of health present opportunities for decision-making, which can target modifiable factors influencing health-i.e. interventions to improve or reduce risks to population health. Future work is needed to build on this review and propose an improved, people-centred and evidence-informed decision-making tool that strongly and explicitly integrates data on social determinants of health