Addressing high cervical cancer rates in the Rio Grande Valley along the Texas-Mexico border: a community-based initiative focused on education, patient navigation, and medical provider training/telementoring.

AIMS: Cervical cancer incidence and mortality rates are approximately 55% higher in the Rio Grande Valley (RGV) along the Texas-Mexico border compared with the average rates in the US. Our aim was to improve cervical cancer prevention efforts in the RGV through a comprehensive multilevel intervention initiative focused on community education, patient navigation, and training of local providers. METHODS: We initiated a program in the RGV which consisted of (1) community education, (2) patient navigation, and (3) a training/mentoring program for local medical providers including hands-on training courses coupled with telementoring using Project ECHO® (Extension for Community Health Outcomes). We assessed the number of women undergoing cervical cancer screening, diagnosis, and treatment at three participating clinics caring for underserved women in the region. RESULTS: From November 2014 to October 2018, 14,846 women underwent cervical cancer screening. A total of 2030 (13.7%) women underwent colposcopy for abnormal results (179% increase over baseline) and 453 women underwent loop electrosurgical excision procedures (LEEPs) for treatment of cervical dysplasia. Invasive cancer was diagnosed in 39 women who were navigated to a gynecologic oncologist for treatment. Seven local medical providers were trained to perform colposcopy and/or LEEP. Project ECHO telementoring videoconferences were held every 2 weeks for a total 101 sessions with an average of 22 participants per session and a total of 180 patient cases presented and discussed. CONCLUSIONS: Our program led to a large number of women undergoing diagnosis and treatment of cervical dysplasia in the RGV. If sustained, we anticipate these efforts will decrease cervical cancer rates in the region. The program is currently being expanded to additional underserved areas of Texas and globally to low- and middle-income countries.

Perspectives on cervical cancer screening and prevention: challenges faced by providers and patients along the Texas-Mexico border.

BACKGROUND: The Rio Grande Valley (RGV) and Laredo regions located along the Texas-Mexico border consist of seven counties with a population of approximately 1.5 million people and a high uninsured rate (33.5%). Cervical cancer mortality in these border counties is approximately 30% higher than the rest of Texas. The RGV and Laredo areas were studied to better understand the state of access to cervical cancer prevention services along the Texas-Mexico border. METHODS: Data on the population served and the services provided were analyzed to determine the gap between cervical cancer screenings recommended versus those received. Through interviews, we gathered the perspectives of 16 local stakeholders regarding cervical cancer screening for underserved individuals in the region. FINDINGS: It is estimated that 69,139 uninsured women aged 21-64 years in the RGV/Laredo per year are recommended to undergo cervical cancer screening with Papanicolaou (Pap) and/or human papillomavirus (HPV) testing, but only 8941 (12.9%) Pap tests are being performed by the Federally Qualified Health Center (FQHC) serving uninsured women in these regions. Systemic barriers identified include insufficient provider clinical capacity, the high cost of healthcare, and uncertainty about government funding sources. Patient barriers identified include inadequate knowledge on navigating the local healthcare system, low health literacy, lack of money and childcare, an inability to miss work, limited transportation, and fear of deportation. CONCLUSION: Decreasing the disparity between cervical cancer screening services provided and those recommended requires addressing the barriers, identified by local experts, which prevent uninsured women from accessing care. These challenges are being addressed through ongoing programs and collaborations.

Virulence of the fish pathogen Aeromonas dhakensis: genes involved, characterization and histopathology of experimentally infected hybrid tilapia.

Aeromonas dhakensis (Ad) CAIM 1873 growth was evaluated at different conditions and antibiotic susceptibility. Mortality and histopathological damages in hybrid tilapia Oreochromis niloticus × O. mossambicus, and virulence factors caused by Ad bacterial cells and extracellular products (ECPs) were evaluated, and the whole genome was obtained. Ad grew between 0.0 and 5.5% NaCl at a pH of between 4 and 10 and from 4 to 37°C. The lowest minimum inhibitory concentration was found for enrofloxacin (<5 µg ml-1), and bacteria were resistant to erythromycin, amoxicillin and ampicillin. Ad bacterial cells (1.86 × 105 cells g-1) and ECPs (0.462 µg protein fish-1) were highly virulent to challenged hybrid tilapia and caused over 80% mortality at 24 h. The primary clinical sign caused was haemorrhage, and damage was most marked in the spleen, liver, kidney and brain of fish challenged with bacterial cells. To our knowledge, this is the first report that Ad causes pyknotic and karyorrhectic nuclei of erythrocytes in the internal organs of hybrid tilapia, which was the most striking histopathological observation. The virulence of Ad to hybrid tilapia may be primarily related to the activity of haemolysins (hlyA genes) and cytotoxins (aerolysin aerA), along with the production of siderophores and proteases. We also found ß-lactamase, tetracycline and multiple antibiotic resistance genes, as well as adherence, iron acquisition, toxins (aerolysin family, haemolysins) and diverse protease genes.

[Evaluation of the combination of psychosocial and pharmacological treatment in schizophrenic patients]. / Evaluación de la combianación de los tratamientos psicosocial y farmacológico en pacientes con esquizofrenia.

INTRODUCTION: The present treatment of schizophrenia should initially focus on bringing psychotic symptoms under control with the use of antipsychotic medication, but it also should include the psychosocial management of the illness, with the implementation of psychosocial treatment. The purpose of the present study is to describe the results of the comparison of two groups (experimental and control) of schizophrenic out-patients of The National Institute of Psychiatry Ramón de la Fuente in Mexico City. The experimental group received a combination of psychosocial and pharmacological treatment, while the control group received the pharmacological treatment alone. MATERIAL AND METHODS: A quasi-experimental design which included the two groups under study, experimental (n=25) and control group (n=22), was used. Both groups were assessed at the beginning and at the end of a one-year interventions considering variables such as: symptomatology, psychosocial functioning, global functioning, compliance with antipsychotic medication, relapses, rehospitalizations, therapeutic non-compliance, and adherence. RESULTS: Experimental patients, in comparison with control patients, improved their symptomatology, psychosocial functioning and global functioning considerably. They also presented the following: lower relapse frequency - 12% versus 31,8% of the controls as well as low rehospitalizacion rate - 0% versus 13.6% of the control patients, higher antipsychotic medication compliance (90%) when compared with patients under the control condition (80%), a reduced rate of therapeutic non-compliace (19.3%) and a higher degree of adherence (80.7%). On the other hand, control patients remained stabilized in their symptomatology, but did not improved in any of the psychosocial variables. CONCLUSIONS: The results show that the combination of psychosocial and pharmacological therapy is a more effective form of treatment in comparison with the other approach of pharmacotherapy alone. It may be concluded that there is sound evidence that indicates that combined psychosocial and pharmacological therapy combined report beneficial effects for the patients; therefore, it should be considered as an important therapeutic alternative in the treatment of schizophrenic patients.

[Psychosocial factors associated with hospital readmission of patients with organic psychoses]. / Factores psicosociales relacionados con la rehospitalización de pacientes con psicosis orgánica.

OBJECTIVE: To assess the relationship between psychosocial factors, frequent relapses and hospital readmissions in patients with organic psychoses. MATERIAL AND METHODS: A cross-sectional descriptive study was conducted among 33 patients diagnosed with organic psychosis, seen at Hospital Psiquiatrico Guillermo Dávila, of Instituto Mexicano del Seguro Social in Mexico City. Patients had been readmitted more than two occasions during 1993-1994. Data collection instruments consisted of recorded interviews, five-minute dialogues of expressed emotions (EE), and combined questionnaires to assess perception of illness and the physician-patient relationship. The Kappa statistic and Cronbach's alpha were used to establish the validity and reliability of the measurements; descriptive and inferential methods were used for statistical data analysis. RESULTS: A high percentage (60.9%) of patient's relatives showed high level of EE, as measured by their expression of criticism, hostility, or emotional over-involvement; 64.3% of study subjects lived for more than 35 hours per week with relatives having high EE levels. CONCLUSIONS: High EE levels were associated with frequent readmissions to the psychiatric ward. Greater perception of illness characteristics was observed among relatives than in patients. Even though a satisfactory physician-patient relationship was found, it was not conducive to improving the perception of illness nor compliance with therapy.

Fungal agents isolated from cancer patients.

With the aim to know the frequency of mycotic agents in patients with different types of cancer, samples were obtained from 81 patients from the Hospital de Oncología, Centro Médico Nacional Siglo XXI, IMSS from May 1995 through May 1996. In a conventional grouping seven (7) ambulatory patients were found in early stages, twenty seven (27) occasionally hospitalized patients were found in intermediate stage and forty seven (47) hospitalized patients in terminal stage of cancer. The different samples were processed through routine mycologycal methods and the following fungi species were isolated and identified: fifty four strains (58%) of Candida albicans followed by eleven strains (11.8%) of Candida tropicalis, six strains (6.45%) of Candida parapsilosis, five strains (5.37%) of Candida krusei, four strains (4.3%) of Candida humicola and five strains (5.37%) of Rodothorula rubra. From medical devices like catheter tips, drainage catheters (Pen rouse, Foley) and gallbladder catheters; four (4) strains of C. albicans, three (3) strains of Rodothorula rubra and two (2) strains of Aspergillus sp were isolated. Of the Candida non albicans it was relevant to find C. krusei more frequently than Rodothorula rubra, Aspergillus sp and Penicillum sp. The frequency of the presence of fungi increases commensurately to the advancement of the clincal stage of the cancer.