[Evaluation of interventions during the COVID-19 pandemic: development of a model based on subpopulations with different contact rates]

Si bien se han realizado múltiples intentos de modelar matemáticamente la pandemia de la enfermedad por coronavirus 2019 (COVID-19), causada por SARS-CoV-2, pocos modelos han sido pensados como herramientas interactivas accesibles para usuarios de distintos ámbitos. El objetivo de este trabajo fue desarrollar un modelo que tuviera en cuenta la heterogeneidad de las tasas de contacto de la población e implementarlo en una aplicación accesible, que permitiera estimar el impacto de posibles intervenciones a partir de información disponible. Se desarrolló una versión ampliada del modelo susceptible-expuesto-infectado-resistente (SEIR), denominada SEIR-HL, que asume una población dividida en dos subpoblaciones, con tasas de contacto diferentes. Asimismo, se desarrolló una fórmula para calcular el número básico de reproducción (R₀) para una población dividida en n subpoblaciones, discriminando las tasas de contacto de cada subpoblación según el tipo o contexto de contacto. Se compararon las predicciones del SEIR-HL con las del SEIR y se demostró que la heterogeneidad en las tasas de contacto puede afectar drásticamente la dinámica de las simulaciones, aun partiendo de las mismas condiciones iniciales y los mismos parámetros. Se empleó el SEIR-HL para mostrar el efecto sobre la evolución de la pandemia del desplazamiento de individuos desde posiciones de alto contacto hacia posiciones de bajo contacto. Finalmente, a modo de ejemplo, se aplicó el SEIR-HL al análisis de la pandemia de COVID-19 en Argentina; también se desarrolló un ejemplo de uso de la fórmula del R₀. Tanto el SEIR-HL como una calculadora del R₀ fueron implementados informáticamente y puestos a disposición de la comunidad.

Experimental rat model of chronic cerebral hypoperfusion-reperfusion mimicking normal perfusion pressure breakthrough phenomenon

BACKGROUND

Normal perfusion pressure breakthrough (NPPB) phenomenon is a major life-threatening complication that restricts the treatment of complex intracranial arteriovenous malformations. The aim of the study it to develop a rat model mimicking NPPB phenomenon that enables the evaluation of any therapy to prevent such complication.

METHODS

Twenty Wistar male rats were randomly assigned to either a study or a control group. Study animals underwent an end-to-side left external jugular vein-common carotid artery anastomosis and ligation of bilateral external carotid arteries. Control animals only underwent ligation of bilateral external carotid arteries. All animals were sacrificed sixty days after the procedure. Hemodynamic parameters [mean arterial pressure (MAP), intracranial pressure (ICP) and cerebral perfusion pressure (CPP)], blood-brain barrier (BBB) permeability (measured by fluorescein staining) and histological features were then compared between both groups.

RESULTS

A significant decrease in MAP and CPP was confirmed in the study group. An increase in ICP was also observed. A significant decrease in MAP and CPP was also present in the study group when comparing preoperative values with those recorded on days 0 (postoperative), 7 and 60. Fluorescein staining findings were consistent with signs of BBB disruption in study animals. Histological analysis demonstrated an increased number of pyknotic neurons in the ipsilateral hemisphere of rat brains included in the study group.

CONCLUSION

These results confirm that this model mimics a vascular steal state with chronic cerebral hypoperfusion comparable to patients with AVMs behavior and disruption of the BBB after fistula closure comparable to NPPB phenomenon disorders.

Arquitectura de procesos con indicadores estratégicos en los servicios médicos de consulta externa en hospitales de alta especialidad

Introduction

The importance of granting high specialty outpatient services calls for a diagnosis through process architecture in order to measure outpatient services deferral with key performance indicators and to evaluate the opportunity of scheduling appointments at high specialty hospitals.

Objective

To apply the process architecture model and key performance indicators in high specialty hospitals, in order to analyze outpatient appointment scheduling activities and to improve the quality of medical care and patient safety.

Method

Quantitative, sequential and deductive reasoning study, with correlational scope, to assess the degree of association between variables, and to establish and define key performance indicators, according to the importance of activities in medical services. A convenience sample in time and by accessibility to two high specialty hospitals in Mexico city was used.

Results

Deferral in outpatient services was measured with an emphasis on the analysis of 19 indicators for a proposal of strategies.

Conclusions

The model of priority indicators of the architecture of medical processes is presented through the analysis of activities, which comprehensively visualizes medical care and allows improving the quality of the medical services provided to the patient.

Adolescents' physical activity is associated with previous and current physical activity practice by their parents

OBJECTIVE

The purpose of this study was to determine whether parents' current and previous physical activity practice is associated with adolescents' physical activity.

METHODS

The sample was composed of 1231 adolescents (14-17 years), and 1202 mothers and 871 fathers were interviewed. Weight and height of the adolescents were measured. Self-reported parents' weight and height were obtained. The current and previous physical activity levels (Baecke's questionnaire) of parents (during childhood and adolescence) and adolescents' physical activity levels were obtained using a questionnaire. The magnitude of the associations between parent and adolescent physical activity levels was determined by binary logistic regression (adjusted by sex, age, and socioeconomic level of adolescents and education level of parents).

RESULTS

The current physical activity practice by parents was associated with adolescents' physical activity (p<0.001). The physical activities reported by parents in their childhood and adolescence were also associated with higher physical activity levels among adolescents. Adolescents whose parents were both physically active in the past and present were six times (OR=6.67 [CI=1.94-22.79]) more likely to be physically active compared to adolescents with no parents who were physically active in the past.

CONCLUSIONS

The current and previous physical activities of parents were associated with higher levels of physical activity in adolescents, even after controlling for confounding factors.