Enhancing access to alcohol use disorder pharmacotherapy and treatment in primary care settings: ADaPT-PC

Background: Only 7.8% of individuals meeting diagnostic criteria for alcohol use disorder (AUD) receive treatment in a given year. Most individuals with AUDs are identified in primary care (PC) settings and referred to substance use disorders (SUD) clinics; however, only a minority of those referred attend treatment services. Safe and effective pharmacological treatments for AUD exist, but they are rarely prescribed by PC providers. The objective of this study is to refine, implement, and evaluate an intervention to integrate pharmacological AUD treatment options into PC settings. This paper provides a detailed description of the intervention design and the evaluation components. Methods/design: Three large Veterans Health Administration (VHA) facilities are participating in the intervention. The intervention targets stakeholder groups with tailored strategies based on implementation theory and prior research identifying barriers to implementation of AUD pharmacotherapy. Local SUD providers and primary care mental health integration (PCMHI) providers are trained to serve as local implementation/clinical champions and receive external facilitation. PC providers receive access to consultation from local and national clinical champions, educational materials, and a dashboard of patients with AUD on their caseloads for case identification. Veterans with AUD diagnoses receive educational information in the mail just prior to a scheduled PC visit. Effectiveness of the intervention will be evaluated through an interrupted time series with matched controls to monitor change in facility level AUD pharmacotherapy prescribing rates. Following Stetler\u27s four-phase formative evaluation (FE) strategy, FE methods include (1) developmental FE (pre-implementation interviews with champions, PC providers, and Veterans), (2) implementation-focused FE (tracking attendance at facilitation meetings, academic detailing efforts by local champions, and patient dashboard utilization), (3) progress-focused FE (tracking rates of AUD pharmacotherapy prescribing and rates of referral to PCMHI and SUD specialty care), and (4) interpretive FE (post- implementation interviews with champions and PC providers). Analysis of FE data will be guided by the Consolidated Framework for Implementation Research (CFIR). Discussion: If demonstrated to be successful, this implementation strategy will provide a replicable, feasible, and relative low-cost method for integrating AUD treatment services into PC settings, thereby increasing access to AUD treatment

Enhancing access to alcohol use disorder pharmacotherapy and treatment in primary care settings: ADaPT-PC.

BACKGROUND: Only 7.8 % of individuals meeting diagnostic criteria for alcohol use disorder (AUD) receive treatment in a given year. Most individuals with AUDs are identified in primary care (PC) settings and referred to substance use disorders (SUD) clinics; however, only a minority of those referred attend treatment services. Safe and effective pharmacological treatments for AUD exist, but they are rarely prescribed by PC providers. The objective of this study is to refine, implement, and evaluate an intervention to integrate pharmacological AUD treatment options into PC settings. This paper provides a detailed description of the intervention design and the evaluation components. METHODS/DESIGN: Three large Veterans Health Administration (VHA) facilities are participating in the intervention. The intervention targets stakeholder groups with tailored strategies based on implementation theory and prior research identifying barriers to implementation of AUD pharmacotherapy. Local SUD providers and primary care mental health integration (PCMHI) providers are trained to serve as local implementation/clinical champions and receive external facilitation. PC providers receive access to consultation from local and national clinical champions, educational materials, and a dashboard of patients with AUD on their caseloads for case identification. Veterans with AUD diagnoses receive educational information in the mail just prior to a scheduled PC visit. Effectiveness of the intervention will be evaluated through an interrupted time series with matched controls to monitor change in facility level AUD pharmacotherapy prescribing rates. Following Stetler\u27s four-phase formative evaluation (FE) strategy, FE methods include (1) developmental FE (pre-implementation interviews with champions, PC providers, and Veterans), (2) implementation-focused FE (tracking attendance at facilitation meetings, academic detailing efforts by local champions, and patient dashboard utilization), (3) progress-focused FE (tracking rates of AUD pharmacotherapy prescribing and rates of referral to PCMHI and SUD specialty care), and (4) interpretive FE (post-implementation interviews with champions and PC providers). Analysis of FE data will be guided by the Consolidated Framework for Implementation Research (CFIR). DISCUSSION: If demonstrated to be successful, this implementation strategy will provide a replicable, feasible, and relative low-cost method for integrating AUD treatment services into PC settings, thereby increasing access to AUD treatment

Renal cell carcinoma in tuberous sclerosis complex

Renal cell carcinoma (RCC) occurs in 2% to 4% of patients with tuberous sclerosis complex (TSC). Previous reports have noted a variety of histologic appearances in these cancers, but the full spectrum of morphologic and molecular features has not been fully elucidated. We encountered 46 renal epithelial neoplasms from 19 TSC patients and analyzed their clinical, pathologic, and molecular features, enabling separation of these 46 tumors into 3 groups. The largest subset of tumors (n=24) had a distinct morphologic, immunologic, and molecular profile, including prominent papillary architecture and uniformly deficient succinate dehydrogenase subunit B (SDHB) expression prompting the novel term "TSC-associated papillary RCC (PRCC)." The second group (n=15) were morphologically similar to a hybrid oncocytic/chromophobe tumor (HOCT), whereas the last 7 renal epithelial neoplasms of group 3 remained unclassifiable. The TSC-associated PRCCs had prominent papillary architecture lined by clear cells with delicate eosinophilic cytoplasmic thread-like strands that occasionally appeared more prominent and aggregated to form eosinophilic globules. All 24 (100%) of these tumors were International Society of Urological Pathology (ISUP) nucleolar grade 2 or 3 with mostly basally located nuclei. Tumor cells from 17 of 24 TSC-associated PRCCs showed strong, diffuse labeling for carbonic anhydrase IX (100%), CK7 (94%), vimentin (88%), and CD10 (83%) and were uniformly negative for SDHB, TFE3, and AMACR. Gains of chromosomes 7 and 17 were found in 2 tumors, whereas chromosome 3p deletion and TFE3 translocations were not detected. In this study, we reported a sizable cohort of renal tumors seen in TSC and were able to identify them as different morphotypes, which may help to expand the morphologic spectrum of TSC-associated RCC

Feasibility and impact of Creciendo Sanos, a clinic-based pilot intervention to prevent obesity among preschool children in Mexico City

Background: Mexico has the highest adult overweight and obesity prevalence in the Americas; 23.8% of children <5 years old are at risk for overweight and 9.7% are already overweight or obese. Creciendo Sanos was a pilot intervention to prevent obesity among preschoolers in Instituto Mexicano del Seguro Social (IMSS) clinics. Methods: We randomized 4 IMSS primary care clinics to either 6 weekly educational sessions promoting healthful nutrition and physical activity or usual care. We recruited 306 parent-child pairs: 168 intervention, 138 usual care. Children were 2-5 years old with WHO body mass index (BMI) z-score 0-3. We measured children’s height and weight and parents reported children’s diet and physical activity at baseline and 3 and 6-month follow-up. We analyzed behavioral and BMI outcomes with generalized mixed models incorporating multiple imputation for missing values. Results: 93 (55%) intervention and 96 (70%) usual care families completed 3 and 6-month follow-up. At 3 months, intervention v. usual care children increased vegetables by 6.3 servings/week (95% CI, 1.8, 10.8). In stratified analyses, intervention participants with high program adherence (5-6 sessions) decreased snacks and screen time and increased vegetables v. usual care. No further effects on behavioral outcomes or BMI were observed. Transportation time and expenses were barriers to adherence. 90% of parents who completed the post-intervention survey were satisfied with the program. Conclusions: Although satisfaction was high among participants, barriers to participation and retention included transportation cost and time. In intention to treat analyses, we found intervention effects on vegetable intake, but not other behaviors or BMI. Trial registration ClinicalTrials.gov NCT01539070. Comisión Nacional de Investigación Científica del IMSS: 2009-785-120

Love in the Time of COVID-19: Negligence in the Nicaraguan Response

The response of the Nicaraguan government to the coronavirus disease 2019 (COVID-19) pandemic has been perhaps the most erratic of any country in the world to date. Directly contradicting mitigation strategies recommended by WHO, President Daniel Ortega has refused to encourage any physical distancing measures. Vice President Rosario Murillo (Daniel Ortega\u27s wife) instead called on thousands of sympathisers to congregate in street marches under the slogan \u27love in the time of COVID-19\u27. By downplaying the danger of the pandemic and increasing the risk of community transmission in the second-poorest country in the western hemisphere, the Nicaraguan government is violating the human rights of its citizens

Endometrial carcinoma, grossing and processing issues: recommendations of the International Society of Gynecologic Pathologists.

Endometrial cancer is the most common gynecologic neoplasm in developed countries; however, updated universal guidelines are currently not available to handle specimens obtained during the surgical treatment of patients affected by this disease. This article presents recommendations on how to gross and submit sections for microscopic examination of hysterectomy specimens and other tissues removed during the surgical management of endometrial cancer such as salpingo-oophorectomy, omentectomy, and lymph node dissection-including sentinel lymph nodes. In addition, the intraoperative assessment of some of these specimens is addressed. These recommendations are based on a review of the literature, grossing manuals from various institutions, and a collaborative effort by a subgroup of the Endometrial Cancer Task Force of the International Society of Gynecological Pathologists. The aim of these recommendations is to standardize the processing of endometrial cancer specimens which is vital for adequate pathological reporting and will ultimately improve our understanding of this disease

Pathologic Prognostic Factors in Endometrial Carcinoma (Other Than Tumor Type and Grade)

Although endometrial carcinoma (EC) is generally considered to have a good prognosis, over 20% of women with EC die of their disease, with a projected increase in both incidence and mortality over the next few decades. The aim of accurate prognostication is to ensure that patients receive optimal treatment and are neither overtreated nor undertreated, thereby improving patient outcomes overall. Patients with EC can be categorized into prognostic risk groups based on clinicopathologic findings. Other than tumor type and grade, groupings and recommended management algorithms may take into account age, body mass index, stage, and presence of lymphovascular space invasion. The molecular classification of EC that has emerged from the Cancer Genome Atlas (TCGA) study provides additional, potentially superior, prognostic information to traditional histologic typing and grading. This classifier does not, however, replace clinicopathologic risk assessment based on parameters other than histotype and grade. It is envisaged that molecular and clinicopathologic prognostic grouping systems will work better together than either alone. Thus, while tumor typing and grading may be superseded by a classification based on underlying genomic abnormalities, accurate assessment of other pathologic parameters will continue to be key to patient management. These include those factors related to staging, such as depth of myometrial invasion, cervical, vaginal, serosal surface, adnexal and parametrial invasion, and those independent of stage such as lymphovascular space invasion. Other prognostic parameters will also be discussed. These recommendations were developed from the International Society of Gynecological Pathologists Endometrial Carcinoma project

Resultados preliminares de caracterización y evaluación de cepas de Pseudomonas aeruginosa obtenidas, a partir de infecciones de fuente nosocomial, comunitaria, de animales y del ambiente

En el marco del proyecto de investigación denominado “Caracterización y evaluación de cepas de Pseudomonas aeruginosa obtenidas a partir de infecciones de fuente nosocomial, comunitaria, de animales y del ambiente” 11/V262. 2018-2022 del Programa de Incentivos para Docentes Investigadores. Se recibieron P. aeruginosa aisladas de pacientes con diferentes patologías de 2 nosocomios situados uno en la Ciudad de La Plata y otro en Berazategui. También se estudiaron cepas procedentes de animales enfermos y del ambiente aisladas del Servicio de Laboratorios de Análisis Bacteriológicos y Antimicrobianos FCV, UNLP, del laboratorio de diagnóstico e investigación “Fenix Linzay” y del Laboratorio de Asuntos Agrarios de la Prov. de Buenos Aires. Se procesó un total de 238 muestras. En todos los casos se confeccionó una ficha epidemiológica para pacientes humano o animal y para muestras ambientales. Se recolectaron diversos datos, edad, sexo, grupo etareo, datos clínicos, caracterización del paciente (colonizado o infectado), patología de base u otras. Para las muestras ambientales, origen de la muestra y características. Se construyó una base de datos a fin de analizar la prevalencia anual de la Infección en ambos nosocomios. Y en los distintos ambientes.Facultad de Ciencias Veterinaria

Color afterimages in autistic adults

It has been suggested that attenuated adaptation to visual stimuli in autism is the result of atypical perceptual priors (e.g., Pellicano and Burr in Trends Cogn Sci 16(10):504–510, 2012. doi:10.​1016/​j.​tics.​2012.​08.​009). This study investigated adaptation to color in autistic adults, measuring both strength of afterimage and the influence of top-down knowledge. We found no difference in color afterimage strength between autistic and typical adults. Effects of top-down knowledge on afterimage intensity shown by Lupyan (Acta Psychol 161:117–130, 2015. doi:10.​1016/​j.​actpsy.​2015.​08.​006) were not replicated for either group. This study finds intact color adaptation in autistic adults. This is in contrast to findings of attenuated adaptation to faces and numerosity in autistic children. Future research should investigate the possibility of developmental differences in adaptation and further examine top-down effects on adaptation

La merienda escolar, aliada de la buena alimentación

En Argentina menos de 30 productos representan más de la mitad del gasto en alimentos de los hogares pobres, y más del 85% de las calorías y nutrientes ingeridos. La alimentación en los sectores de menores ingresos es muy parecida en todo el territorio, si bien en el Noroeste un poco más de mandioca o en el Sur un poco más de cordero. La dieta de los pobres es monótona por problemas económicos y determina déficit de nutrientes y micronutrientes. En los hogares de nivel socioeconómico medio-alto aún conserva rasgos de monotonía por exceso en el consumo de alimentos muy industrializados, alto contenido de azúcares y grasas saturadas y pobre contenido de fibra. En la Provincia de San Luis, se ha reglamentado la LEY Nº III-0743-2010 “MEjor alimentacion, mas salud”, homologada por el Decreto del Poder Ejecutivo Nº  2826, por el cual se ha implementado también un Programa del Ministerio de Salud de la Provincia, con el objetivo de difundir en las escuelas el establecimiento de “Kioscos  saludables”, con el propósito fundamental de proveer a los distintos actores de la comunidad educativa una merienda que respete las características de saludable, accediendo a ella en forma responsable y voluntaria, respetando las Leyes de la Nutrición: suficiente, completa, armónica, adecuada e inocua. Desde el Programa de Extensión de la Universidad Nacional de San Luis, en colaboración con INTA San Luis, nos propusimos investigar la realidad en una escuela de nivel medio de la ciudad de Villa Mercedes (S.L) junto a docentes del nivel primario y secundario de la escuela. Se realizaron talleres para indagar los hábitos alimenticios de niños de 5to grado, (tres divisiones). Se usaron técnicas de juego y grupos donde los niños pudieron expresar mediante dibujos y recortes tres consignas: 1) qué les gustaba comer, 2) qué comían habitualmente, 3) qué alimentos no habían comido nunca. Se valoraron los alimentos más nutritivos y a su vez sanos y se brindaron recomendaciones para la buena alimentación a niños y mediante trípticos divulgativos llegamos a sus padres. Los resultados obtenidos luego de la evaluación de las encuestas y los afiches mostró que los niños de clase media tienen una dieta poco variada, que hay muchos alimentos que nunca se han probado y que sus gustos van dirigidos a alimentos de alto contenido graso y poco valor nutricional. Se espera en el segundo año de ejecución del proyecto indicadores de cambio de hábitos nutricionales en los alumnos con los que se ha trabajado en la concientización y educación en dieta saludable.