Innovative treatment formats, technologies, and clinician trainings that improve access to behavioral pain treatment for youth and adults

Chronic pain is prevalent across the life span and associated with significant individual and societal costs. Behavioral interventions are recommended as the gold-standard, evidence-based interventions for chronic pain, but barriers, such as lack of pain-trained clinicians, poor insurance coverage, and high treatment burden, limit patients’ ability to access evidenced-based pain education and treatment resources. Recent advances in technology offer new opportunities to leverage innovative digital formats to overcome these barriers and dramatically increase access to high-quality, evidenced-based pain treatments for youth and adults. This scoping review highlights new advances. First, we describe system-level barriers to the broad dissemination of behavioral pain treatment. Next, we review several promising new pediatric and adult pain education and treatment technology innovations to improve access and scalability of evidence-based behavioral pain treatments. Current challenges and future research and clinical recommendations are offered

Sociocultural and epidemiological aspects of HIV/AIDS in Mozambique

<p>Abstract</p> <p>Background</p> <p>A legacy of colonial rule coupled with a devastating 16-year civil war through 1992 left Mozambique economically impoverished just as the human immunodeficiency virus (HIV) epidemic swept over southern Africa in the late 1980s. The crumbling Mozambican health care system was wholly inadequate to support the need for new chronic disease services for people with the acquired immunodeficiency syndrome (AIDS).</p> <p>Methods</p> <p>To review the unique challenges faced by Mozambique as they have attempted to stem the HIV epidemic, we undertook a systematic literature review through multiple search engines (PubMed, Google Scholar™, SSRN, AnthropologyPlus, AnthroSource) using Mozambique as a required keyword. We searched for any articles that included the required keyword as well as the terms 'HIV' and/or 'AIDS', 'prevalence', 'behaviors', 'knowledge', 'attitudes', 'perceptions', 'prevention', 'gender', drugs, alcohol, and/or 'health care infrastructure'.</p> <p>Results</p> <p>UNAIDS 2008 prevalence estimates ranked Mozambique as the 8^thmost HIV-afflicted nation globally. In 2007, measured HIV prevalence in 36 antenatal clinic sites ranged from 3% to 35%; the national estimate of was 16%. Evidence suggests that the Mozambican HIV epidemic is characterized by a preponderance of heterosexual infections, among the world's most severe health worker shortages, relatively poor knowledge of HIV/AIDS in the general population, and lagging access to HIV preventive and therapeutic services compared to counterpart nations in southern Africa. Poor education systems, high levels of poverty and gender inequality further exacerbate HIV incidence.</p> <p>Conclusions</p> <p>Recommendations to reduce HIV incidence and AIDS mortality rates in Mozambique include: health system strengthening, rural outreach to increase testing and linkage to care, education about risk reduction and drug adherence, and partnerships with traditional healers and midwives to effect a lessening of stigma.</p

The promotion of condom use in non-regular sexual partnerships in urban Mozambique.

This study uses data from a representative sample of sexually active adults in urban Mozambique to examine the effectiveness of the JeitO condom social marketing (CSM) project in increasing condom use among men and women at risk of contracting HIV. More specifically, this study tests the hypothesis that exposure to programme interventions (communications and access) increases condom use with non-regular partners. Exposure to the CSM programme is high, and multivariate analyses show that exposure to CSM advertising and communications and knowledge of a condom source are associated with higher reports of condom use with non-regular partners. Analyses of regional differences in condom use show that knowledge and use of condoms with non-regular partners are higher than the national average in all four provinces where the CSM project has been operating for longer (18 months vs. 6 months). Multivariate analyses show that the above-average level of condom use in the capital, Maputo, can be attributed to the higher socioeconomic status of this population, but the above-average level of condom use among men and women in Sofala and Manica provinces is due, in part, to their high level of exposure to the CSM programme. These findings indicate that the JeitO CSM project's behaviour-change communications and condom distribution are effective in encouraging safer sex practices among persons engaged in sex with non-regular partners

Diatom paleolimnological record of Holocene climatic and environmental change in the Altai Mountains, Siberia

The sedimentary diatom records of three shallow lakes in the Altai Mountains, southern Siberia, were examined to assess the nature and timing of Holocene environmental changes. Few paleoenvironmental records, especially reconstructions not based on pollen, have been reported from this region. The lakes differ in elevation, annual precipitation, and catchment vegetation. Diatom assemblages in all lakes were dominated for the entire period of record by small benthic species of Pseudostaurosira Williams & Round, Staurosira Ehrenberg, and Staurosirella Williams & Round. Planktonic taxa only occur in very low abundances (\u3c5%). The most diverse diatom flora was found in Dzhangyskol, which is situated at the lowest elevation within a forested catchment. A lack of detailed information on the ecological preferences of the dominant taxa and the complexity of environmental drivers make direct interpretation of the diatom record difficult. However, other proxies suggest that dramatic shifts in dominance between Staurosira elliptica and Staurosirella pinnata in Grusha Ozero reflect millennial-scale variability in climate. Together, chironomids and diatoms provide evidence of a cooling possibly correlative to the Younger Dryas Stade and subsequent early-Holocene warming consistent with pollen evidence of afforestation, which also is likely linked to increased humidity. By 6,000 cal year BP, the transition to a cooler, more continental climate had begun. The diatom record of Akkol shows significantly less variation in diatom community composition, but biogenic silica accumulation rates, a proxy for diatom productivity, appear to reflect climatic variability driven by insolation trends over the past 8,000 years. Long-term variability in Dzhangyskol is not clearly linked to climate

Evolution of the Lake Titicaca basin and its diatom flora over the last ~ 370,000 years

In recent years, deep drilling undertaken as part of the International Continental Drilling Program has generated multiple long lacustrine sedimentary records to reconstruct continental paleoclimate. In many cases, the tectonic and geomorphic history of these basins is under-constrained and poorly known, which affects the interpretation of climate history from geophysical, geochemical, and paleobiotic proxies in the sedimentary record. In addition, non-analog biotic assemblages that reflect evolutionary processes may constrain the reconstruction of past environments. In the drill-core record of Lake Titicaca, spanning the last ~ 370 ka, the diatom stratigraphy reflects both the influence of climate and the longterm evolution of the lake basin and its biota. In the upper part of the drill-core sequence, glacial intervals were deep and dominated by freshwater planktic taxa, and peak interglacial intervals were shallow and dominated by benthic species, some with saline affinities. In the basal sections of the drill-core record, benthic diatoms are dominant in both glacial and interglacial units, with freshwater taxa dominating the glacial strata. This suggests that the ancient lake basin was shallower during intervals of both wet and dry climate, and that the modern deep lake may result from a progressive subsidence and deepening of the basin over time. In addition, morphological evolution in one of the major lineages of planktic diatoms, Cyclostephanos, indicates substantial change in the limnological environment that affected species morphology and may have driven speciation

Physical and Chemical Limnology of a 61-lake Transect across Mainland Nunavut and Southeastern Victoria Island, Central Canadian Arctic

We describe the physical and chemical properties of sixty-one tundra lakes, sampled in a latitudinal transect (65-71°N, 105-108°W) across mainland and island regions of Nunavut, central Canadian Arctic, and examine the influence of geology, geography, climate, and vegetation on lake water chemistry. This dataset complements earlier limnological surveys of the Canadian Arctic and provides valuable information for evaluating the vulnerability of tundra lakes to predicted climate change. Principal components analysis revealed a geographical clustering of lakes; pH, DIC, specific conductivity, and trace metal concentrations reflected major lithological differences between the mainland and Victoria Island. Clustering of mainland lakes by ecoregion was also detected. Lakes of the Queen Maud Gulf Lowland and Garry Lake Lowland ecoregions (north) differed from lakes of the Takijuq Lake Upland ecoregion (south) in depth, pH, and specific conductivity as well as nutrient, DOC, and chlorophyll-a concentrations. Ionic composition of the northern mainland lakes also indicated that the influence of marine aerosols and/or leaching of residual marine salts from post-glacial marine deposits exposed by isostatic rebound. The northern mainland lakes were the most nutrient-rich and biologically productive of the three lake clusters and were characterized by median concentrations of total dissolved nitrogen (518 μg l−1) and chlorophyll-a (1.6 μg l−1) that were higher than previously reported for tundra lakes in the Canadian Arctic. These lakes were chemically similar to lakes of the Tuktoyaktuk Peninsula, in the western Canadian Arctic. Lakes of the southern mainland were dilute, acidic, and nutrient-poor, in accord with earlier limnological surveys in this ecoregion. Concentrations of nutrients, DOC, and chlorophyll-a in Victoria Island lakes fell in the middle of the ranges reported from other islands in the Canadian Arctic. Lithologic and edaphic factors strongly influenced the limnological properties of the tundra lakes surveyed and must be controlled for in order to fully evaluate the influence of future climate and vegetation change

Retro-orbital and disseminated B-cell lymphoma in a yellow-collared macaw (Primolius auricollis).

A yellow-collared macaw was presented with unilateral left exophthalmia. The complete blood cell count and biochemistry revealed a heterophilic leukocytosis and elevation in liver parameters, respectively. A computed tomography scan showed a contrast-enhancing retrobulbar mass and hepatomegaly. Cytology of the liver was consistent with a round cell tumor, most likely lymphoma. The bird died after 2 months of palliative care. Postmortem examination confirmed a retro-orbital and disseminated B-cell lymphoma