Medwave最新文献

Introduction: Artificial intelligence (AI) is increasingly present in dermatology, demonstrating accuracy levels comparable to, or even superior to, those of dermatologists in diagnosing skin lesions from clinical and dermoscopic images. This review provides an overview of AI's role in the automated classification and monitoring of skin lesions.

Objective: To explore and map the existing literature on the use and benefits of AI in dermatology.

Methods: This narrative review focused on exploring the use and benefits of AI in dermatology, utilizing MeSH/DeCS terms such as "Dermatology," "Artificial Intelligence," "Diagnosis," and "Computer Aided Diagnosis." Three databases (PubMed, Lillacs, and Scopus) from 2008 to 2024. We excluded articles that did not focus on dermatology, lacked the topic of Artificial Intelligence, or presented theoretical designs without practical application or evidence, resulting in a final selection of forty-four articles.

Results: The results strongly support AI's effectiveness, displaying its precision in diagnosis, comparable to or exceeding that of human dermatologists across diverse tasks. The evolution of AI in dermatology implies a substantial transformation in care, extending its applications from skin cancer to various dermatological pathologies. While emphasizing the vital collaboration between AI and healthcare professionals, a critical gap remains in the real-world clinical validation of AI. Ethical considerations, especially in automated decision-making, need careful attention.

Conclusions: This narrative review highlights the crucial role of AI in dermatology, emphasizing its potential to enhance diagnostic accuracy for skin lesions.

Introduction: Perceived workplace discrimination is a relevant phenomenon in the field of occupational health, associated with multiple negative effects on work outcomes, mental and physical health. However, the literature reveals significant limitations in its measurement, such as the absence of validated instruments for this purpose. This study aimed to develop, validate the content, and evaluate the reliability of a questionnaire designed to measure perceived workplace discrimination.

Methods: We designed a questionnaire based on a scoping review of the literature. The instrument consists of two sections. The first section includes four items aimed at assessing the prevalence of perceived workplace discrimination and the associated reasons. The second section comprises ten items designed to characterize the phenomenon using a Likert-type scale. Content validity was assessed by five experts using Aiken's V coefficient with 95% confidence intervals. Internal consistency of the second section was evaluated through Cronbach's alpha coefficient. The sample included 86 workers from the mining sector in Chile.

Results: The 14 items in the questionnaire obtained Aiken's V values ranging from 0.8 to 1, indicating high clarity, relevance, and significance. The reliability analysis of the second section yielded a Cronbach's alpha coefficient of 0.62, considered acceptable for exploratory stages. Opportunities for improvement were identified in some items to enhance internal cohesion in future applications.

Conclusions: The questionnaire demonstrates high content validity and moderate reliability, supporting its preliminary use in research on perceived workplace discrimination. Further studies are recommended to confirm its factor structure and strengthen its psychometric properties in larger and more diverse samples.

Climate change is a serious threat to public health. The intensity and devastation of 21st-century climate events exacerbate the vulnerability of certain social groups that already face historical disadvantages. The objective of this article is to examine various dimensions of health vulnerability in the context of anthropogenic climate change. A narrative review was conducted based on articles published in the last five years from the Scopus, Medline/PubMed, LILACS databases, and an intentional search of current publications by international organizations and commissions focused on the topic. The review identified and characterized four types of health vulnerability dimensions: social, economic, geographic, and health infrastructure; it also presents multiple intersectionalities that converge at the interface of climate change and health which increase the risk of physical and mental illnesses. Based on the proposed discussion, public policy guidelines are suggested for resilient health systems and effective information structures for timely decision-making.

Introduction: Shift work refers to labor arrangements that fall outside the standard daytime schedule and is associated with various health, safety, and productivity concerns. Numerous studies have linked shift work to sleep disturbances, chronic diseases, reduced well-being, and impaired performance. However, there is no consensus in the literature regarding which specific shift variables should be assessed, hindering comparability across studies and the formulation of evidence-based recommendations.

Objective: To explore which shift work variables have been investigated in the scientific literature in relation to the health, productivity, safety, and well-being of workers in land, air, and maritime transport, in both freight and passenger services.

Methods: A scoping review will be conducted following the PRISMA-ScR guidelines and the Joanna Briggs Institute methodology. The literature search will be performed in PubMed and Scopus, including studies published in English and Spanish between 2015 and March 2025. Two reviewers will independently screen titles, abstracts, and full texts using Rayyan, and extract relevant data using a predefined data charting form. Methodological quality will be assessed using validated tools such as the Mixed Methods Appraisal Tool (MMAT) or the JBI critical appraisal checklists. A narrative synthesis will be used to summarize and map the key findings.

Expected results: This review aims to enhance conceptual and methodological clarity in the study of shift work by providing a structured synthesis of the variables investigated in relation to key occupational outcomes. Findings will be relevant for researchers, occupational health professionals, and policymakers seeking to design more targeted and effective interventions.

Introduction: Limb and respiratory muscle weakness acquired in the intensive care unit (ICU) are commonly associated with long-term functional impairments. However, the extent to which axial muscles might be affected remains poorly understood. Therefore, this study aims to explore the association between axial muscle performance assessed through a supine bridging activity and physical function across critical illness recovery. Secondarily, we investigated the predictability of the supine bridging activity with the walking ability.

Methods: Prospective observational study of patients who walked independently before admission and were mechanically ventilated for ≥48 hours in a Chilean medical ICU. The assessment session, conducted on awakening, ICU discharge, and high-dependency unit (HDU) discharge, included the supine bridging activity (performance scored from 0 to 5, with higher scores representing better performance, and lifting duration in seconds) and walking ability. Performance over-time was compared by Friedman’s test for multiple comparisons (Bonferroni corrections). Logistic regressions were used to explore the association of supine bridging activity with in-hospital walking ability. We also produced a Receiver Operating Characteristic curve for the predictability of walking ability.

Results: We enrolled 33 adults, completing 86 supine bridging activity assessments across time points. Supine bridging activity performance improved significantly over time, with a median (P25 to P75) of 2 (1 to 4) on awakening, 3 (1 to 5) at ICU discharge, and 5 (2 to 5) at HDU discharge (p<0.001). Higher supine bridging activity scores on awakening were associated with a significantly higher likelihood of walking at HDU discharge (odds ratio: 12.17; 95% CI: 1.36 to 108.68; p=0.025). Lifting >14.5 seconds during the supine bridging activity at awakening predicted walking ability at HDU discharge (area under the curve=0.77).

Conclusions: Supine bridging activity performance on awakening was associated with walking ability post ICU discharge, with potential implications on rehabilitation interventions aimed at improving axial muscle strength from early stages of critical illness.

Introduction: The COVID-19 pandemic exposed the weaknesses of epidemiological surveillance systems and highlighted the need to integrate new respiratory viruses into sentinel surveillance systems. However, current evidence on their effectiveness remains limited.

Aim: This project conducts a scoping review to describe the available evidence on the integration of COVID-19 into sentinel surveillance systems.

Methods: The included studies addressed sentinel surveillance in the context of the pandemic following the World Health Organization declaration. A systematic search was performed in databases including MEDLINE, LILACS, EPISTEMONIKOS, and DIMENSIONS, selecting observational studies and systematic reviews. Data collection and analysis were organized into categories such as clinical characteristics, timely detection, geographic representativeness, co-infection, and adaptability with genomic surveillance. Seventeen studies reporting on COVID-19 integration impact and one preliminary WHO report were identified.

Results: Results identified the most prevalent symptoms in the general population: fever (73%), cough (51.8%), loss of taste or smell (45.1%), hypoxemia (33%), and sputum production (23.9%). A high correlation was obtained between SARI cases or hospitalizations due to respiratory infection and the incidence of COVID-19 (ρ = 0.78 and ρ = 0.82 respectively).

Conclusions: Integrating COVID-19 into the sentinel surveillance system could improve detection, response, and follow-up capacity. Additionally, implementing standardized case definitions promotes more efficient use of laboratory resources, thereby enhancing the sustainability of the surveillance system.

Introduction: Elective abdominal hysterectomy is often accompanied by high preoperative anxiety and stress, which can exacerbate postoperative pain.

Objectives: To determine whether the addition of pain neuroscience education to standard preanesthetic evaluation reduces preoperative anxiety and perceived stress and decreases postoperative pain among women undergoing elective total abdominal hysterectomy.

Methods: This single-center randomized controlled trial will enroll 62 adult female patients. Participants will be randomly assigned, in a 1:1 ratio, to the intervention group-standard preanesthetic assessment and pain neuroscience education-or the control group-standard preanesthetic assessment alone. Primary outcomes (pain on the Visual Analog Scale [VAS], anxiety on the Beck Anxiety Inventory [BAI],, and total score on the Perceived Stress Scale [PSS]) will be assessed at three time points: preoperatively, 1 hour postoperatively, and 8 hours postoperatively. Secondary outcomes will include the Quality of Recovery-15 (QoR-15) score and the requirement for rescue analgesia.

Expected results: We anticipate that integrating pain neuroscience education with standard preanesthetic evaluation will reduce anxiety and stress, decrease postoperative pain intensity, and improve overall recovery in women undergoing elective hysterectomy.

Registration: ClinicalTrials.gov Identifier: NCT05435508.