How do people who use drugs experience treatment? A qualitative analysis of views about opioid substitution treatment in primary care (iCARE study)

OBJECTIVE: To understand the most significant aspects of care experienced by people in opioid substitution treatment (OST) in primary care settings. DESIGN: Semistructured individual interviews were conducted, following the critical incidents technique. Interview transcripts were analysed following a thematic analysis approach. PARTICIPANTS: Adults aged 18 years or older, receiving OST in UK-based primary care services. RESULTS: Twenty-four people in OST were interviewed between January and March 2019. Participants reported several aspects which were significant for their treatment, when engaging with the primary care service. These were grouped into 10 major themes: (1) humanised care; (2) individual bond/connection with the professional; (3) professionals' experience and knowledge; (4) having holistic care; (5) familiarity; (6) professionals' commitment and availability to help; (7) anonymity; (8) location; (9) collaborative teamwork; and (10) flexibility and changes around the treatment plan. CONCLUSIONS: This study included first-hand accounts of people who use drugs about what supports them in their recovery journey. The key lessons learnt from our findings indicate that people who use drugs value receiving treatment in humanised and destigmatised environments. We also learnt that a good relationship with primary care professionals supports their recovery journey, and that treatment plans should be flexible, tailor-made and collaboratively designed with patients

Continuity and change in human resources policies for health: lessons from Brazil

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Salivary gland tumors in children and adolescents: a clinicopathologic and immunohistochemical study of fifty-three cases

Objective: Salivary gland tumors in children and adolescents are rare. Most papers are case reports or short series of cases. The aim of this study was to analyze clinicopathological and immunohistochemical data from a large series of salivary gland tumors affecting youngsters from a single institution. Methods: From 1953 to 1997, 53 patients 18 years old or less with epithelial salivary gland tumors from the Hospital do Cancer A.C. Camargo were studied. Clinical. and treatment data were obtained from the medical records and histological features were reviewed. Paraffin-embedded tissues were immunohistochemically analyzed for p53, PCNA, Ki-67, bcl-2, c-erbB-2, and CEA. Results: Twenty-seven tumors (51%) were benign and 26 (49%) malignant. Pleomorphic adenoma (PA) was the most common tumor type (49%), followed by mucoepidermoid carcinoma (MEC, 39.6%). The tumors were more common in female and 50.9% of the cases affected the parotid, followed by 26.4% of intraoral involvement. Immunohistochemical analysis did not show correlation with prognosis of the tumors. Twenty (74%) of the 27 patients with benign tumors were alive without evidence of disease after a mean of 16.5 years of follow up; 6 were lost of follow up and 1 died by causes not related to the disease. Nineteen (73%) of the 26 patients with malignant tumors did not show tumoral recurrence after a mean follow up of 14.3 years, and 3 (11.5%) patients died of the disease. Conclusions: In 53 cases of epithelial salivary gland tumors in youngsters, half were malignant, with favorable prognosis. On this series, immunohistochemical expression of p53, PCNA, Ki-67, c-erbB-2, bcl-2, and CEA, were not correlated with prognosis. (C) 2004 Elsevier Ireland Ltd. ALL rights reserved.68789590

PCNA, Ki-67 and p53 expressions in submandibular salivary gland tumours

Salivary gland tumours are uncommon with a broad heterogeneity. The most common benign tumour is the pleomorphic adenoma, whereas mucoepidermoid carcinoma and adenoid cystic carcinoma predominate among. the malignancies. Most salivary gland tumours occur in the parotid, and consequently clinical and biological data are normally derived from this site. This work describes the expressions of PCNA, Ki-67 and p53 in 15 pleomorphic adenomas, 15 mucoepidermoid carcinomas and 15 adenoid cystic carcinomas of the submandibular gland. Our results showed that all pleomorphic adenomas were negative for p53 and Ki-67 with 66.6% being positive for PCNA. Conversely, p53 was positive in 53% of the mucoepidermoid carcinomas and in 20% of the adenoid cystic carcinomas. Ki-67 was expressed in 47.7% of the mucoepidermoid carcinomas and 40% of the adenoid cystic carcinomas. All malignant tumours were positive for PCNA. These results indicate that the proliferative rate analysed with PCNA and Ki-67 and the expression of p53 in pleomorphic adenoma and adenoid cystic carcinoma of the submandibular gland were similar to those described in the parotid and minor salivary glands. However, mucoepidermoid carcinomas showed higher expression of these markers than those of other salivary glands. This work is the first describing the expression of these immunohistochemical markers exclusively in submandibular. salivary gland tumours.33659359

Juvenile intraoral pleomorphic adenoma: report of five cases and review of the literature

The aim of this study is to report on five cases of intraoral pleomorphic adenoma (PA) in patients under 18 years of age and to review the literature. Intraoral salivary gland tumours were reviewed in two Brazilian institutions and five cases of PA in patients under 18 years of age were found. Clinical data were obtained from the medical records and paraffin-embedded tissues were sectioned for proliferating cell nuclear antigen (PCNA) and p53 immunohistochemical analysis. Four patients were female and one was male; two cases affected the palate, two the upper lip and one the tongue. All five patients were treated surgically and after long follow-up periods no recurrences were observed. Tumour cells were weakly positive for PCNA and negative for p53. PA should be considered in the differential diagnosis of submucosal nodules in young patients. In youngsters, PA seems to have similar biological characteristics as in adults, with low recurrence rates after surgical resection.31327327