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BACKGROUND: The use of technologies has had a significant impact on patient safety and the quality of care and has increased globally. In the literature, it has been reported that people die annually due to adverse events (AEs), and various methods exist for investigating and measuring AEs. However, some methods have a limited scope, data extraction, and the need for data standardization. In Brazil, there are few studies on the application of trigger tools, and this study is the first to create automated triggers in ambulatory care. OBJECTIVE: This study aims to develop a machine learning (ML)-based automated trigger for outpatient health care settings in Brazil. METHODS: A mixed methods research will be conducted within a design thinking framework and the principles will be applied in creating the automated triggers, following the stages of (1) empathize and define the problem, involving observations and inquiries to comprehend both the user and the challenge at hand; (2) ideation, where various solutions to the problem are generated; (3) prototyping, involving the construction of a minimal representation of the best solutions; (4) testing, where user feedback is obtained to refine the solution; and (5) implementation, where the refined solution is tested, changes are assessed, and scaling is considered. Furthermore, ML methods will be adopted to develop automated triggers, tailored to the local context in collaboration with an expert in the field. RESULTS: This protocol describes a research study in its preliminary stages, prior to any data gathering and analysis. The study was approved by the members of the organizations within the institution in January 2024 and by the ethics board of the University of São Paulo and the institution where the study will take place. in May 2024. As of June 2024, stage 1 commenced with data gathering for qualitative research. A separate paper focused on explaining the method of ML will be considered after the outcomes of stages 1 and 2 in this study. CONCLUSIONS: After the development of automated triggers in the outpatient setting, it will be possible to prevent and identify potential risks of AEs more promptly, providing valuable information. This technological innovation not only promotes advances in clinical practice but also contributes to the dissemination of techniques and knowledge related to patient safety. Additionally, health care professionals can adopt evidence-based preventive measures, reducing costs associated with AEs and hospital readmissions, enhancing productivity in outpatient care, and contributing to the safety, quality, and effectiveness of care provided. Additionally, in the future, if the outcome is successful, there is the potential to apply it in all units, as planned by the institutional organization. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/55466.
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Atención Ambulatoria , Aprendizaje Automático , Humanos , Brasil , Seguridad del PacienteRESUMEN
This study investigated lead (Pb) and cadmium (Cd) transfer in three dairy farming areas in the Mantaro river headwaters in the central Peruvian Andes and at varying distances from the mining complex at La Oroya. At each of these sites, the transfer of trace metals from the soil to raw milk was estimated, and a hazard assessment for lead and cadmium was carried out in scenarios of minimum, average, and maximum milk consumption in a Peruvian population aged 2-85. Pb and Cd were quantified by flame atomic absorption spectrometry. Significantly, the concentrations of lead and cadmium were found to exceed the maximum limits recommended by the World Health Organization, with a positive geospatial trend correlated with the distance from mining activity. Both Pb and Cd were found to be transferred through the soil-pasture-milk pathway, with the primary source of Cd being phosphate-based fertilizers used in pasture improvement. Pb was found to be the most significant contributor to the Hazard Index (HI) with those under 19 years of age and over 60 recording an HI of >1, with infants being the most vulnerable group due to their greater milk consumption in relation to their body weight. A marginal increase in contamination was observed in the dry season, indicating the need for studies to be expanded over several annual cycles.
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The risk to human health from exposure to certain pollutants through the consumption of fruits, tubers, and fish were evaluated in a settlement located in a Colombian area highly impacted by gold mining activities. The concentrations of mercury (Hg) and arsenic (As) in edible food tissues and methylmercury (MeHg) in fish were determined for risk assessment. A questionnaire-based dietary survey was answered by 178 residents of three population groups: children (CHD), women of childbearing age (WCBA), and the rest of the population (RP). The estimated weekly intake (EWI) of MeHg presented values of 1.9 and 2.4 times higher than the provisional tolerable weekly intake (1.6 µg/kg BW/week) recommended by the FAO/WHO for CH and WCBA, respectively. The results of the HQ values of As and Hg for different food were above the safety level (HQ < 1) for most of the groups. For Hg, the highest HQ values correspond to fish, whereas for As in most of the food, but specially in fruits. The total target hazard quotients (HI) were higher than 1, in all the groups (except for CHD that consume tubers) indicating potential non-carcinogenic health risks. The values of carcinogenic risk (CR) for As through exposure to food ranged from 1.2·10-4 to 7.7·10-4, well above than the safety level of US EPA risk (10-4-10-6), suggesting the probability of carcinogenic risk for the entire population via ingestion. Therefore, safety control mechanisms and environmental education strategies should be applied to address food intake, associated with good agricultural practices to provide solutions to protect the health of the residents in areas affected by gold mining activities.
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Arsénico , Contaminación de Alimentos , Mercurio , Minería , Arsénico/efectos adversos , Arsénico/análisis , Niño , Colombia , Femenino , Contaminación de Alimentos/análisis , Oro , Humanos , Mercurio/efectos adversos , Mercurio/análisis , Compuestos de Metilmercurio/efectos adversos , Compuestos de Metilmercurio/análisis , Medición de RiesgoRESUMEN
SUMMARY OBJECTIVES: Cardiovascular diseases are also considered to increase the risk of death in COVID-19 patients. However, real-world data concerning the risk factors for death in patients with severe COVID-19 still remain vague. This study aimed to identify the potential risk factors associated with mortality in severe COVID-19 patients. METHODS: All consecutive patients admitted to the intensive care unit (ICU) of our institute for COVID-19 for severe COVID-19 pneumonia from April 1, 2020 to July 20, 2020 were included in the analysis. Patient characteristics, including complete medical history and comorbid diseases, blood test results during admission and on day 7, and clinical characteristics were compared between survivors and nonsurvivors. RESULTS: There was no significant difference between survivors and nonsurvivors regarding age, gender, and preexisting cardiovascular diseases. Moreover, the rate of the medications including angiotensin-converting enzyme (ACE) inhibitor and angiotensin receptor blockers did not differ between survivors and nonsurvivors. The peak C-reactive protein (CRP), procalcitonin, fibrinogen, and d-dimer levels and the rate for chronic renal failure were significantly higher in nonsurvivors compared with survivors. Intubated patients had a higher risk of death than the others had. CONCLUSIONS: This study failed to demonstrate a significant difference in preexisting cardiovascular diseases and cardiovascular medications between survivors and nonsurvivors who were admitted to ICU for severe COVID-19. Our findings indicate that the presence of chronic renal failure, a high peak ferritin concentration, and the need for invasive mechanical ventilation appear predictive for mortality. We propose that these risk factors should be taken into account in defining the risk status of severe COVID-19 patients admitted to the ICU.
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Humanos , Fármacos Cardiovasculares , COVID-19 , Factores de Riesgo , SARS-CoV-2 , Unidades de Cuidados IntensivosRESUMEN
Agricultural soils need monitoring systems to address pesticide risks for humans and the environment. The purpose of this paper was to obtain leaching risk maps of the pesticides imidacloprid, lambda-cyhalothrin, and chlorpyrifos in agricultural soil under an onion (Allium cepa L.) crop in Tibasosa, Boyacá, Colombia. This was obtained by studying the soil types in the area, analyzing the behavior of pollutants in the soil profile, using a delay factor and an attenuation factor to finally include GIS allowing visualization of the areas of greater potential risk in the study area.
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This study assesses the potential human health risks posed by six heavy metals (Hg, As, Pb, Cd, Cu, and Zn) found in five of the most consumed fish species (Mugil incilis, Centropomus undecimalis, Cathorops mapale, Eugerres plumieri, and Elops smithi) collected by the riverine population living in Ciénaga Grande de Santa Marta (CGSM), the largest estuary in Colombia. Metal concentrations were low compared with those reported in other regions around the world and the maximum value established by international monitoring organizations. The estimation of the potential risk (HQ) indicated that Cu and Hg could generate negative effects in groups of women of childbearing age (WCA) and the remaining population (RP), because they exceeded their related reference doses, with HQ values > 1; however, Cu and Hg concentrations were not high in fish and EWI, MFW, or MeHgPSL values shows that there is no evidence of a potential health risk from MeHg exposure in the study population. Therefore, the recommendations are to establish continuous monitoring of heavy metals together with strategies that address the high fish consumption, as well as to implement mechanisms for the mitigation of contamination of the watershed, to ensure the safety of organisms in the ecosystem and human health, not only of populations who depend on aquatic resources in the area but also of those that market and consume these resources in the Colombian Caribbean.
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Metales Pesados , Contaminantes Químicos del Agua , Adulto , Animales , Región del Caribe , Niño , China , Colombia , Ecosistema , Monitoreo del Ambiente , Estuarios , Femenino , Peces , Contaminación de Alimentos , Humanos , Metales Pesados/toxicidad , Medición de Riesgo , Contaminantes Químicos del Agua/toxicidadRESUMEN
Colombia is a fish exporter and consumer country because of its geographical location. Since 2012, imported fish have become a more economical option than domestic species due to free trade agreements. Concentrations of Pb, Cd, and Zn were evaluated in three imported and highly commercialized fish species in a city on the Caribbean coast of Colombia: Prochilodus lineatus, Prochilodus reticulatus, and Pangasianodon hypophthalmus, plus one brand of canned tuna and one brand of sardines. The canned species showed the highest values for Pb, Cd, and Zn; canned tuna (oil-packed) contained 0.189 ± 0.047 mg/kg Pb and 238.93 ± 76.43 mg/kg Zn, while canned sardines contained 0.111 ± 0.099 mg/kg Cd, suggesting a relationship between the canning process and the metal concentrations. The estimated daily intake (EDI) and hazard quotient (HQ) suggested that there is no risk for consumer health in the short term, but the presence of these heavy metals certainly should be a concern in the long term because of the bioaccumulation phenomenon due to the high intake of these fish species in this coastal and tourist community. It is recommended that continuous monitoring of heavy metal concentrations take place to protect communities in a local and global context.
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Monitoreo del Ambiente , Peces , Contaminación de Alimentos/análisis , Metales Pesados/análisis , Alimentos Marinos/análisis , Animales , Colombia , Medición de RiesgoRESUMEN
The decline in marine and freshwaters catches in recent years in Colombia has led to a change in dietary habits, with an increase in the purchase and consumption of imported fish. This is of particular concern as fish are sometimes caught in mercury-contaminated waters, and are subsequently sold canned or uncanned. In addition, canned tuna has received little attention as it is widely assumed that concentrations are low. In this study, total mercury (THg) and methylmercury (MeHg) concentrations were evaluated in three imported fish species marketed in Colombia, Prochilodus lineatus, Prochilodus reticulatus, and Pangasianodon hypophthalmus, plus four brands of canned tuna and one of sardines. One brand of tuna showed the highest mean concentrations of THg (0.543⯱â¯0.237⯵g/g, wet weight, ww) and MeHg (0.518⯱â¯0.337⯵g/g ww), while concentrations in P. hypophthalmus were approximately 30 times lower (≈0.02⯵g/gâ¯ww). The estimated weekly intake (EWI) in children was above the provisional tolerable weekly intake (PTWI) of MeHg established by the Joint FAO/World Health Organization (WHO) Expert Committee on Food Additives (JECFA) in 2007, 1.6⯵g/kg body weight (bw) per week, for all the canned tuna brands. Values for adults were below PTWI, whereas for women of childbearing age, values were above PTWI only for brand D of canned tuna. The estimate of the potential risk indicated that MeHg levels in canned tuna can generate negative effects in vulnerable groups, while the EWI of fresh fish did not pose a threat to the general population. Therefore, establishing strategies to address the high consumption of canned tuna, and continuous monitoring to control commercial food, are recommended to decrease Hg exposure.
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Contaminación de Alimentos , Mercurio/análisis , Compuestos de Metilmercurio/análisis , Alimentos Marinos/análisis , Animales , Región del Caribe , Niño , Colombia , Femenino , Peces , Alimentos en Conserva/análisis , Humanos , Medición de RiesgoRESUMEN
The health risks of metal exposure due to the high consumption of fish were assessed for a riverine population living on the Caribbean coast of Colombia. The concentrations of metals (Cd, Cr, Cu, Hg, Ni, Pb and Zn) in the edible tissues of fish were determined and used for risk assessment. The daily fish consumption of residents (n = 95) was as high as 283, 366 and 469 g/day in children (CH), women of childbearing age (WCHA) and the remaining population groups (RP), respectively. The estimation of the potential risk (HQ) indicated that there was no health risk from most of the metals, because they did not exceed their related reference doses, with values of HQ < 1. Although the concentrations of Pb and Hg were not particularly high in fish (<0.2 µg/g), their possible health effects for vulnerable groups are of great concern due to the extremely high fish intake. The Pb intake for all groups was higher than the lower confidence limit of the benchmark dose for nephrotoxicity and neurodevelopmental effects in children. The weekly intake of methylmercury was also elevated, with values approximately 3, 2 and 1.5 times the provisional tolerable weekly intake for CH, WCHA and RP, respectively. Moreover, higher Hg levels were found in top predators, whereas maximum levels for other metals were found in bottom-feeding fish. This study highlights that an accurate data of daily intake, a continuous monitoring of metals in fish and their related fish consumption advisories to protect subsistence fishing communities are recommended in a local and worldwide context.