Implementation science: Scaling a training intervention to include IUDs and implants in contraceptive services in primary care.

Building capacity for contraceptive services in primary care settings, including for intrauterine devices (IUDs) and implants, can help to broaden contraceptive access across the US. Following a randomized trial in family planning clinics, we brought a provider training intervention to other clinical settings including primary care in all regions. This implementation science study evaluates a national scale-up of a contraceptive training intervention to varied practice settings from 2013 to 2019 among 3216 clinic staff serving an estimated 1.6 million annual contraceptive patients. We measured providers' knowledge and clinical practice changes regarding IUDs and implants using survey data. We estimated the overall intervention effect, and its relative effectiveness in primary care settings, with generalized estimating equations for clustered data. Patient-centered counseling improved, along with comfort with method provision and removal. Provider knowledge increased (p < 0.001), as did evidence-based counseling for IUDs (aOR 3.3 95% CI 2.8-3.9) and implants (aOR 3.5, 95% CI 3.0-4.1), and clinician competency in copper and levonorgestrel IUDs (aORs 1.8-2.6 95% CIs 1.5-3.2) and implants (aOR 2.4 95% CI 2.0-2.9). While proficiency was lower initially in primary care, gains were significant and at times greater than in Planned Parenthood health clinics. This intervention was effectively scaled, including in primary care settings with limited prior experience with these methods. Recent changes to Title X family planning funding rules exclude several large family planning providers, shifting greater responsibility to primary care and other settings. Scaling effective contraceptive interventions is one way to ensure capacity to offer patients full contraceptive services

Efectividad de peloidoterapia en tiña pedis

Se realiza estudio descriptivo prospectivo, para caracterizar el uso de la peloidoterapia en pacientes con tiña pedis asistidos en el Hospital “Dr. Agosthino Neto” de Guantánamo desde enero 2006–febrero 2007. Se comprueba insuficiente conocimiento sobre peloides como modalidad de Medicina Natural y Tradicional (MNT) en tratamiento de tiña pedis. El universo está constituido por 120 pacientes hombres con diagnóstico clínico y micológico de tiña pedis, se les ofrece tratamiento diario con peloides. La tiña pedis escamosa resulta ser la forma clínica más común, el mayor porcentaje está en pacientes de 25-34 años y entre 15 y 29 días de evolución de la enfermedad, antes de iniciar el tratamiento con peloides. El Trichophyton Rubrum es el agente causal más común del estudio micológico. La mayor proporción de pacientes mejoran con peloidoterapia, particularmente aquellos con forma escamosa de tiña pedis. Se expresan resultados en cuadros y gráficos, se arriba a conclusiones