Acceptability and Feasibility of Survivorship Group Medical Visits for Breast Cancer Survivors in a Safety Net Hospital.

Providing cost-effective, comprehensive survivorship care remains a significant challenge. Breast cancer survivors (BCS) who have limited income and are from marginalized racial and ethnic groups experience a worse quality of life and report higher distress. Thus, innovative care models are required to address the needs of BCS in low resource settings. Group medical visits (GMV), utilized in chronic disease management, are an excellent model for education and building skills. This single-arm intervention study was conducted at a public hospital in California. GMVs consisted of five 2-h weekly sessions focused on survivorship care planning, side effects of treatment and prevention, emotional health, sexual health, physical activity, and diet. The patient navigators recruited three consecutive GMV groups of six English-speaking BCS (N = 17). A multidisciplinary team delivered GMVs, and a patient navigator facilitated all the sessions. We used attendance rates, pre- and post-surveys, and debriefing interviews to assess the feasibility and acceptability of the intervention. We enrolled 18 BCS. One participant dropped out before the intervention started, 17 BCS consistently attended and actively participated in the GMV, and 76% (13) attended all planned sessions. Participants rated GMVs in the post-survey and shared their support for GMVs in debriefing interviews. The BCS who completed the post-survey reported that GMVs increased their awareness, confidence, and knowledge of survivorship care. GMVs were explicitly designed to address unmet needs for services necessary for survivorship care but not readily available in safety net settings. Our pilot data suggest that patient-navigator-facilitated GMVs are a feasible and acceptable model for integrating survivorship care in public hospitals.

Corrigendum: Confirmatory factor analysis and gender invariance of the Persian version of psychological control scale: association with internalizing and externalizing behavior problems.

[This corrects the article DOI: 10.3389/fpsyg.2023.1128264.].

Longitudinal pathways of maltreated young children: Family stress processes and adverse childhood experiences.

An important issue associated with at-risk families in the child welfare system is the impact of familial stress processes on child developmental outcomes. The present study used the family stress model (FSM) to examine the impact of economic hardship, economic pressure, caregiver emotional distress, caregiver/partner conflict, caregiver harsh parenting, and adverse childhood experiences (ACEs) on child's cognitive, behavioral, and social outcomes. Data from the National Survey on Child and Adolescent Well-Being II were utilized, and 1,363 children (709 male, 654 female) ages 2-18 months (at Wave 1) were included in the present study. Three waves of data were analyzed in the longitudinal structural equation model, with economic hardship and economic pressure at Wave 1, caregiver emotional distress, caregiver/partner conflict, and caregiver harsh parenting at Wave 2 predicting ACEs and child outcomes at Wave 3. Results were overall consistent with the FSM in that economic hardship led to economic pressure, and caregiver emotional distress and caregiver/partner conflict led to harsh parenting, which subsequently led to ACEs. ACEs led to negative child cognitive outcomes, and for female children only, ACEs led to internalizing/externalizing behaviors. The results demonstrate that over time, familial stress processes led to negative child developmental outcomes in this sample. Study results also highlight the inextricable connection between mild harsh parenting behaviors and more severe forms of maltreatment on child outcomes. The prevention of child maltreatment is emphasized, with a specific focus on increasing positive parenting behaviors and decreasing caregiver emotional distress and caregiver/partner conflict. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Closing the Opioid Treatment Gap Through Advance Practice Nursing Activation: Curricular Design and Initial Outcomes.

INTRODUCTION: Buprenorphine, an effective medication for opioid use disorder (MOUD), reduces opioid-related harms including overdose, but a significant gap exists between MOUD need and treatment, especially for marginalized populations. Historically, low MOUD treatment capacity is rising, driven by advanced practice registered nurses (APRNs). A graduate nursing course was designed to increase equitable buprenorphine treatment delivery by APRNs. We report on baseline findings of a curriculum evaluation study with a pretest-posttest design. DESIGN: Computerized surveys assessed trainee satisfaction with the course, trainee knowledge for providing MOUD, and trainee satisfaction in working with people who use drugs. METHODS: Quantitative survey results utilizing Likert scales are presented. RESULTS: Baseline precourse surveys revealed less than half (44%) of APRN students agreed/strongly agreed that they had a working knowledge of drugs and drug-related problems and 37% agreed/strongly agreed that they knew enough about the causes of drug problems to carry out their roles when working with people who use drugs. Approximately two thirds of APRN students agreed/strongly agreed that they want to work with people who use drugs (63%), that it is satisfying to work with people who use drugs (66%), and that it is rewarding to work with people who use drugs (63%). Nearly all students reported high satisfaction with the course. CONCLUSION: APRN students reported high satisfaction with a novel course grounded in health equity that has potential to reduce health disparities and accelerate the closure of the MOUD treatment gap, particularly for racial/ethnic minorities, rural populations, and transition-age youth.

[Pancytopenia associated to acute myeloid leukemia: a case report of aleukemic leukemia]. / Pancitopenia asociada a leucemia mieloide aguda: reporte de un caso de leucemia aleucémica.

Background: Acute myeloid leukemia (AML) is characterized by the presence of ≥ 20% myeloblasts in peripheral blood or bone marrow, as well as specific cytogenetic alterations. It can appear as a de novo disease or be associated with other hematologic diseases, which is why the clinical presentation is heterogeneous. Pancytopenia as a manifestation of aleukemic leukemia is a rare entity. Here, we described a case of AML that presented with pancytopenia as the only manifestation in a secondary care center. Clinical case: 72-year-old man, hospitalized due to pancytopenia, with no history of hematological diseases, asymptomatic, without hepatosplenomegaly or bleeding. Flow cytometry revealed pancytopenia without blasts in peripheral blood. Secondary causes of pancytopenia as infections, splenomegaly and nutritional deficiencies where ruled out. Bone marrow aspirate showed infiltration by 45% of myeloblasts and myelodysplasia. Immunophenotype was compatible with AML. Patient was sent to the Hematology Department at Centro Médico Nacional Siglo XXI (21st Century National Medical Center) to start chemotherapy. Conclusions: AML that is presented as pancytopenia should be considered in the evaluation of marrow failure syndrome. In the context of our hospital, morphological findings remains an essential tool for early diagnosis, since more refined studies such as immunophenotyping and cytogenetic testing are unreachable in a timely manner.

Introducción: La leucemia mieloide aguda (LMA) se caracteriza por presentar ≥ 20% de mieloblastos en sangre periférica o médula ósea, así como alteraciones citogenéticas específicas. Surge como enfermedad de novo o asociada a trastornos hematológicos, por lo que la presentación clínica es heterogénea. La presentación como pancitopenia (leucemia aleucémica) es rara. El objetivo de este trabajo es presentar un caso de LMA que cursó con pancitopenia como única manifestación clínica en un hospital de segundo nivel de atención. Caso clínico: hombre de 72 años, hospitalizado por hallazgo de pancitopenia, sin historial de enfermedades hematológicas, asintomático, sin adenomegalias ni hemorragia. La citometría hemática documentó pancitopenia sin blastos en sangre periférica. Se descartaron causas secundarias como infección, esplenomegalia y deficiencias nutricionales. En el aspirado de médula ósea se observó 45% de mieloblastos y mielodisplasia. El inmunofenotipo fue compatible con LMA. El paciente fue referido a Hematología del Centro Médico Nacional Siglo XXI para iniciar quimioterapia. Conclusiones: la LMA que se presenta como pancitopenia debe ser tomada en cuenta en el protocolo diagnóstico de síndrome de falla medular. En el contexto de nuestro hospital, la morfología hematológica sigue siendo una herramienta indispensable para el diagnóstico temprano de este tipo de enfermedades, ya que estudios más sofisticados, como el inmunofenotipo y la citogenética, no se encuentran disponibles de forma oportuna.

Dimensions of Identity Development Scale: Confirmatory factor analysis, gender invariance, and external validity of the Persian version.

The present study was conducted to examine the psychometric properties and gender invariance of the Iranian version of the Dimensions of Identity Development Scale (DIDS). A total of 1453 adolescents (50.8% female; 14-18 years old, mean = 15.48) participated in a cross-sectional study and completed the DIDS and the Youth Self-Report of behavior problems. The Confirmatory Factor Analysis supported the six-factor model of the DIDS, echoing past studies showing the original 5th factor (Exploration in Depth) being divided into Exploration in Depth and Reconsidering the Commitment. The invariance testing showed comparable measurement properties of the DIDS across males and females (strict measurement invariance). Further, behavior problems were associated positively with Ruminative Exploration and negatively with Commitment Making, Identification with Commitments, Exploration in Depth, and Reconsideration of Commitments, whereas the opposite was true for academic performance. A six-factor DIDS was shown to be a valid and reliable measure for the assessment of identity development dimensions among Iranian adolescents. Future studies in the Iranian context evaluating the identity clusters derived from identity dimensions and their gender differences are warranted.

Visión 2030 de la Federación Dental Internacional: un desafío para la estomatología cubana / Vision 2030 of the International Dental Federation: a challenge for Cuban Dentistry

Fundamento: es necesario conocer los desafíos que deben enfrentar la estomatología y la educación superior cubana para accionar ante las limitantes económicas, su relación con la ciencia, la tecnología e innovación, y formación de competencias en los profesionales para lograr el objetivo de la Visión 2030. Objetivo: identificar los desafíos de la Visión 2030 y la valoración de las limitantes económicas e integración con la ciencia, tecnología e innovaciones y el nivel de competencias específicas y transversales en la formación de profesionales en el área de salud. Métodos: se realizó una investigación descriptivo-transversal, en el periodo marzo-mayo 2021, en el Policlínico Universitario "Marta Abreu", de Santa Clara, Villa Clara. Se utilizaron métodos teóricos: análisis-síntesis e inductivo- deductivo; empíricos: encuesta y revisión documental; el matemático para determinar los valores absolutos y porcentaje. Resultados: se identificaron algunos desafíos: ausencia de tecnología apropiada, adopción limitada de iniciativas en la promoción y prevención de salud, compresión de señales de alarma, seguir una trayectoria de aprendizaje y superación constantes, restricciones reales en la integración con la ciencia y la innovación, y fomentar investigaciones prácticas basadas en las habilidades investigativas, comunicativas y de actualización de conocimientos en estudiantes. Conclusiones: la estomatología cubana tiene limitaciones económicas objetivas, que pueden ser superadas con su integración a la ciencia, tecnología e innovación, y el fomento de habilidades que les permitan actuar con creatividad en los escenarios más diversos.

Background: it is necessary to know the challenges that Cuban dentistry and higher education must face in order to act in the face of economic limitations, its relationship with science, technology and innovation, and the training of professional skills to achieve the goal of Vision 2030. . Objective: to identify the challenges of Vision 2030 and the assessment of economic limitations and integration with science, technology and innovations and the level of specific and cross sectional skills in the training of professionals in the health area. Methods: a descriptive-cross-sectional investigation was carried out, from March to May 2021, at "Marta Abreu" University Polyclinic, in Santa Clara, Villa Clara. Theoretical methods were used: analysis-synthesis and inductive-deductive; empirical ones: survey and documentary review; the mathematical to determine the absolute values and percentage. Results: some challenges were identified: absence of appropriate technology, limited adoption of initiatives in health promotion and prevention, understanding of alarm signals, following a path of constant learning and improvement, real restrictions in the integration with science and innovation, and promote practical investigations based on students' researching, communication and knowledge updating skills. Conclusions: Cuban dentistry has objective economic limitations, which can be overcome with its integration into science, technology and innovation, and the promotion of skills that allow them to act creatively in the most diverse scenarios.

Confirmatory factor analysis and gender invariance of the Persian version of psychological control scale: association with internalizing and externalizing behavior problems.

Introduction: The current cross-sectional study aimed to examine the reliability, construct validity, gender invariance and concurrent validity of the psychological control scale-youth self-report (PCS-YSR) among Iranian adolescents. Methods: A total of 1,453 high school students (49.2% boys; Mage = 15.48, SD = 0.97), who aged between 14 and 18 years old completed the PCS-YSR and the youth self-report (YSR) scale of behavior problems. Results: Reliability was established using Cronbach's alpha and ordinal alpha for maternal and paternal psychological control. The confirmatory factor analysis (CFA) results supported the original unidimensional model of the PCS-YSR scale for both mother and father forms. Results also revealed that mother and father forms of PCS-YSR were invariant across adolescents' gender. When comparing the mean differences, mothers were more psychologically controlling toward their sons, compared to their daughters. The mother and father forms of PCS-YSR were found to have acceptable concurrent validity through their relationship to internalizing and externalizing behavioral problems. Discussion: Overall, our findings supported the psychometric properties of the Persian version of the Psychological Control Scale-Youth Self-Report among Iranian adolescents. This scale can be used as an efficient tool for parental psychological control among adolescents in Iran. The negative effect of the intrusive parenting behavior on child' negative outcomes in Iran, irrespective of culture, was shown.

The Explanation of Adolescent Delinquent Behaviors Based on Jessor's Problem Behavior Theory (PBT) in Iran: The Role of Individual Vulnerability, Opportunity Risk Availability, and Perceived Support.

This study tested the generality of Problem Behavior Theory (PBT) in explaining adolescents' problem behavior in Iran. Data were collected from 392 adolescents (Mage = 15.97, SD = 1.12, 55.4% girls) who completed the Adolescent Health and Development Questionnaire (AHDQ) to assess the individual vulnerability, opportunity risk availability, perceived support, and delinquent behaviors. Results indicated that individual vulnerability and opportunity risk availability had a significant relationship with delinquent behaviors and a significant interaction with perceived support in their influence on delinquent behaviors. Further, perceived support was negatively associated with delinquent behaviors. Our results were consistent with PBT's explanatory model for adolescents' problem behavior in Western countries and are informative about problem behavior involvement among Iranian adolescents and the design of interventions.

Basuco consumption in transgender women across three cities in Colombia. / Consumo de basuco en mujeres transgénero, de tres ciudades de Colombia.

This article aims to describe the factors associated with basuco consumption in transgender women (TW) in three cities in Colombia, South America. A cross-sectional descriptive study was carried out using Respondent-Driven Sampling (RDS) and included 688 transgender women participants from Bogotá, Medellín and Santiago de Cali. Descriptive analyses, bivariate associations, and a binomial regression were performed. The prevalence of basuco consumption among participants was 11%; factors associated with basuco consumption among TW included having a low socioeconomic level, living alone, feeling vulnerable to HIV, having had an STI in the last year, and consuming marijuana. Substance consumption in TW in Colombia is high when compared to the general population, and the literature shows that basuco consumption is intensified within a context of social vulnerability. Encouraging the development of policies and programs with a comprehensive approach to health and substance use prevention particularly among vulnerable TW considering their unique sociodemographic and economic characteristics, is warranted.

Este artículo tuvo como objetivo describir los factores asociados al consumo de basuco en mujeres transgénero de tres ciudades de Colombia. Se realizó un estudio descriptivo transversal, a través del muestreo dirigido por los entrevistados (MDE) y en el cual participaron 688 mujeres transgénero de Bogotá, Medellín y Santiago de Cali. Se realizaron análisis descriptivos, asociaciones bivariadas y una regresión de tipo binomial. La prevalencia del consumo de basuco fue de 11%, y los factores asociados a su consumo entre las MT fueron, ser de estrato socioeconómico bajo, vivir sola, percibirse vulnerable al VIH, haber tenido una ITS en el último año y consumir marihuana. El consumo de sustancias en las MT en Colombia es elevado al compararlo con población general, se evidencia que el consumo de basuco se enmarca en el contexto de vulnerabilidad social. Es necesario incentivar la creación de políticas y programas con un abordaje integral en salud, que tengan como uno de los ejes de acción la prevención del consumo de sustancias psicoactivas entre las mujeres transgénero, teniendo en cuenta sus particularidades y características sociodemográficas y económicas.

Contributions from functional neuroimaging studies to the comprehension of traumatic child experiences: preliminary findings / Aportes de los estudios de neuroimagen funcional a la comprensión del trauma infantil: estudio preliminar

Abstract This study aimed to describe the cerebral activation patterns using fMRI (Functional Magnetic Resonance Imaging) technology in a sample of 15 children with Posttraumatic Stress Disorder (PTSD) and 7 with no PTSD. The study used a Quasi-experimental methodology where two experimental tasks were applied: an emotional face task and a version of an emotional Stroop task. The results point out differences in the group of PTSD on the processing of negative stimuli and changes in their frontal lobe activation. These preliminary results suggest that early traumatic experiences affect typical brain development patterns. And explicit and implicit variables involved in the traumatic experiences are discussed as a part of any intervention process.

Resumen El presente estudio tuvo como objetivo describir patrones de activación cerebral mediante una técnica de Imagen por resonancia magnética funcional -fMRI- (abreviatura en inglés de Functional Magnetic Resonance Imaging) en una muestra de niños con Trastorno de estrés postraumático (TEPT) y compararlos con un grupo de controles. Estudio cuasi-experimental en el que se tomó un grupo de 15 niños con TEPT y se comparó con un grupo de 7 niños sin TEPT. Se emplearon dos tareas experimentales: una prueba de caras y una versión del Stroop emocional. Los resultados preliminares, señalan diferencias en el procesamiento de estímulos, principalmente de carácter negativo en los niños con TEPT y cambios en los patrones de activación a nivel de estructuras frontales. Se concluye que el trauma a edad temprana afecta el curso normal del desarrollo cerebral y se evidencia la importancia de abordar los aspectos explícitos e implícitos asociados a la experiencia traumática como parte de la intervención.

Evaluation of Two Serological Assays for Diagnosing Zika Virus Infection.

Zika virus (ZIKV) emerged and spread rapidly in South American countries during 2015. Efforts to diagnose ZIKV infection using serological tools were challenging in dengue-endemic areas because of antigenic similarities between both viruses. Here, we assessed the performance of an in-house developed IgM antibody capture enzyme-linked immunosorbent assay (MAC-ELISA) and the plaque reduction neutralization test (PRNT) to diagnose ZIKV infection. Acute and convalescent paired serum samples from 51 patients who presented with clinical symptoms suggestive of an arbovirus illness in dengue-endemic areas of Honduras, Venezuela, Colombia and Peru were used in the assessment. Samples were tested for ZIKV, dengue and chikungunya virus using a variety of laboratory techniques. The results for the ZIKV-RNA screening and seroconversion detected by the microneutralization test were used to construct a composite reference standard. The overall sensitivity and specificity for the MAC-ELISA were 93.5% and 100.0%, respectively. Contrastingly, the overall sensitivity and specificity for the PRNT were 96.8% and 95.0%, respectively. Restricting the analysis according to IgM or neutralizing antibodies against dengue, the performances of both serological assays were adequate. The findings of this study reveal that the MAC-ELISA and PRNT would provide initial reliable laboratory diagnostic assays for ZIKV infection in dengue-endemic areas.

Emotional memory processing in post-traumatic stress disorder affected Colombian youth.

Post-traumatic stress disorder (PTSD) is a neuropsychological condition caused by exposure to chronic stressors and extreme trauma. In past decades, Colombia (South America) has experienced high levels of armed conflict, which created an environment of chronic stress, resulting in an increased incidence of PTSD in children. Limited research exists on the effects of PTSD on emotional memory functioning of these Colombian youth living in chronically stressful environments. In the present study, 23 PTSD affected youth and 26 controls were asked to recall items from a memorised word list, as well as remembering details from a short emotional story. Although no significant differences were found for word list memory, deficits for emotional story content were found in the PTSD youth, particularly for facts involving negative emotional details. The latter may suggest a deficit in executive functioning for the integration of emotionally laden stimuli, perhaps induced as a by-product of their traumatic experiences.

Prevención de la adicción a narcóticos dirigido a los usuarios que asisten a la consulta de traumatología de un Centro Médico / Prevention of narcotic addiction aimed at users who attend the trauma consultation of the Medical Center / Prevenção da dependência aos narcóticos destinada aos usuários que comparecem à consulta de trauma de um Centro Médico

INTRODUCCIÓN: enfermería mediante el cumplimiento de su función docente promueve actitudes reflexivas en los pacientes para prevenir adicción a los narcóticos. OBJETIVO: información para la prevención de la adicción a narcóticos que tienen los pacientes que asisten a la unidad clínica de traumatología del Centro Médico. MATERIALES Y MÉTODOS: estudio descriptivo, de campo, cuya población estuvo conformada por 50 usuarios, se trabajó con la totalidad, se aplicó estadística descriptiva. Los datos se recogieron mediante cuestionario con 13 ítems con escala de Likert, la validez bajo el juicio de expertos y la confiabilidad por la prueba Alfa de Crombach. RESULTADOS: los resultados señalan que los pacientes ingieren analgésicos distintos a los de la prescripción médica en un 80%, aumentan la dosis diaria prescrita de analgésicos narcóticos siempre en un 50% de la población. Así como también 80% manifestaron la importancia de que los profesionales de enfermería aporten a los usuarios de traumatología información sobre la prevención de la adicción a analgésicos narcóticos. CONCLUSIÓN: los pacientes cumplen más de la dosis de analgésicos indicada por los médicos, además de combinarlos con otros no prescritos y no lo reconocen como una adicción por lo que es importante la información que los profesionales de enfermería puedan aportar al respecto.

INTRODUCTION: nursing by fulfilling its teaching role promotes reflexive attitudes in patients to prevent addiction to narcotics. OBJECTIVE: information for the prevention of narcotic addiction that have the patients who attend the trauma unit of the Medical Center. MATERIALS AND METHODS: descriptive, field study, whose population was made up of 50 users, we worked with all, descriptive statistics were applied. The data were collected by means of a questionnaire with 13 items with a Likert scale, validity under the judgment of experts and reliability by the Alpha test of Cronbach. RESULTS: the results indicate that patients ingest pain relievers other than those prescribed by a doctor by 80%, increase the prescribed daily dose of narcotic pain relievers always by 50% of the population. As well as 80% stated the importance that nursing professionals provide trauma users with information on the prevention of addiction to narcotic pain relievers. CONCLUSIONS: the patients fulfill more than the dose of analgesics indicated by the doctors, in addition to combining them with other non-prescribed ones and do not recognize it as an addiction, so it is important the information that nursing professionals can provide in this regard.

INTRODUÇÃO: a enfermagem, cumprindo seu papel educacional, promove atitudes reflexivas nos pacientes para evitar o vício em narcóticos. OBJETIVOS: facilitar informações objetivas para a prevenção de dependência de narcóticos realizadas por pacientes atendidos no centro de trauma do Centro Médico. MATERIAIS E MÉTODOS: estudo de campo descritivo, cuja população era composta por 50 pacientes, trabalhamos com todos, aplicamos estatística descritiva. Os dados foram coletados por meio de um questionário com 13 itens, tipo escala Likert, previamente avaliado por especialistas da área e com confiabilidade pelo teste Alpha de Crombach. RESULTADOS: os resultados indicam que os pacientes ingerem analgésicos diferentes dos prescritos por médicos em 80%, aumentam a dose diária prescrita de analgésicos narcóticos sempre em 50% da população. Da mesma forma, 80% afirmaram a importância de que os profissionais de enfermagem fornecerem aos pacientes de trauma, informações sobre a prevenção do vício em analgésicos narcóticos. CONCLUSÃO: os pacientes cumprem mais do que a dose de analgésicos indicada pelos médicos, além de combiná-los com outros não prescritos e não o reconhecem como um vício, por isso é importante a informação que os profissionais de enfermagem possam fornecer a esse respeito.

Effect of heavy metals on seed germination and seedling development of Nama aff. stenophylla collected on the slope of a mine tailing dump.

Nama aff. stenophylla plants grow on mining waste abandoned 100 years ago, exposed to high concentrations of heavy metals. Accumulation of heavy metals in plant biomass has been related to the phyto-accessible fractions of these, so we assessed the effect of those heavy metals in different concentrations on the germination and development of seedlings. The seed traits were characterized with optical and scanning electron microscope. The seeds were assessed for dormancy by pre-germinative treatments, germination percentage, tolerance index regarding heavy metals, and the elongation of seedlings under three concentrations of arsenic (As), cadmium (Cd), Iron (Fe), lead (Pb), and zinc (Zn) (phyto-accessible [Ph], five times higher [Hi] and lower [Lo]). The seeds have no dormancy, and the heavy metals did not affect the embryo. Pb, Cd, and As, affected the germination percentage more (p < 0.005). The treatments that most affected seedling elongation were Zn [Hi], Cd [Hi], Pb [Lo], Zn [Ph], Pb [Hi], Zn [Lo] (p < 0.005). The seedlings cells alterations were associated with the reduction in length, although larger cortical cells may be due to heavy metal compartmentalization in vacuoles. The seeds and seedlings showed tolerance to high concentrations of Fe and As, and to phyto-accessible of As, Cd, Pb, and Fe.

Cervical Cancer in Young Women: Do They Have a Worse Prognosis? A Retrospective Cohort Analysis in a Population of Mexico.

BACKGROUND: Cervical cancer (CC) is a global problem; it is among the five leading causes of cancer death in women. Several studies have examined the association between age and disease prognosis; however, controversy still exists. The objective of the present study is to determine if age at diagnosis has an impact on overall survival (OS) and disease-free survival (DFS). MATERIALS AND METHODS: Retrospective cohort of 2,982 patients with CC treated at the National Cancer Institute of Mexico from 2005 to 2015. We collected demographic, clinical, and treatment data, as well as current status, of 2 groups: women under and over 40 years of age. We calculated OS and DFS rates with Kaplan-Meier estimates. Cox proportional hazards modeling was used to determine risks. RESULTS: The median follow-up time was 26.5 months (percentile [P]25 -P75 , 11-60.23). When comparing DFS, OS, stage, and histologic subtype between young patients <40 and adult patients >40, we did not observe any difference. We found that in both groups, locally advanced and advanced stage, neuroendocrine subtype, hydronephrosis, and positive inguinal lymph nodes increased the risks of death and recurrence. Having been pregnant was identified as protective factor in DFS (hazard ratio, 0.54; 95% confidence interval, 0.04-0.71). CONCLUSION: We corroborated that age at diagnosis is not a prognostic factor for decreased or increased OS or DFS, and in both groups, the stage, histologic subtype, hydronephrosis, and node involvement were identified as factors adverse to OS and DFS, and pregnancy history was a protective factor in DFS. IMPLICATIONS FOR PRACTICE: The present study directly affects everyday clinical practice because it allows us to focus on the most relevant prognostic factors in patients with cervical cancer. When planning treatment and follow-up, clinicians should focus on stage at diagnosis, histologic subtype, hydronephrosis, and distant metastasis instead of patients' age. They should also be aware of any previous pregnancies and poor response, or nonresponse, to treatment, which results in disease progression and persistence. Paying attention to these factors affecting overall survival and disease-free survival will help treat patients better and increase their chances of survival and improve their quality of life.

High expression of Helicobacter pylori VapD in both the intracellular environment and biopsies from gastric patients with severity.

Helicobacter pylori is a Gram-negative bacterium that causes chronic atrophic gastritis and peptic ulcers and it has been associated with the development of gastric adenocarcinoma and mucosa-associated lymphoid tissue (MALT). One of the more remarkable characteristics of H. pylori is its ability to survive in the hostile environment of the stomach. H. pylori regulates the expression of specific sets of genes allowing it to survive high acidity levels and nutrient scarcity. In the present study, we determined the expression of virulence associated protein D (VapD) of H. pylori inside adenocarcinoma gastric (AGS) cells and in gastric biopsies. Using qRT-PCR, VapD expression was quantified in intracellular H. pylori-AGS cell cultures at different time points and in gastric mucosa biopsies from patients suffering from chronic atrophic gastritis, follicular gastritis, peptic ulcers, gastritis precancerous intestinal metaplasia and adenocarcinoma. Our results show that vapD of H. pylori presented high transcription levels inside AGS cells, which increased up to two-fold above basal values across all assays over time. Inside AGS cells, H. pylori acquired a coccoid form that is metabolically active in expressing VapD as a protection mechanism, thereby maintaining its permanence in a viable non-cultivable state. VapD of H. pylori was expressed in all gastric biopsies, however, higher expression levels (p = 0.029) were observed in gastric antrum biopsies from patients with follicular gastritis. The highest VapD expression levels were found in both antrum and corpus gastric biopsies from older patients (>57 years old). We observed that VapD in H. pylori is a protein that is only produced in response to interactions with eukaryotic cells. Our results suggest that VapD contributes to the persistence of H. pylori inside the gastric epithelial cells, protecting the microorganism from the intracellular environment, reducing its growth rate, enabling long-term infection and treatment resistance.

Shared Medical Appointments: An Academic-Community Partnership to Improve Care Among Adults With Type 2 Diabetes in California Central Valley Region.

PURPOSE: The purpose of the study was to evaluate the effectiveness of ALDEA (Latinos con Diabetes en Acción), a Shared Medical Appointment (SMA) intervention, compared to usual primary care (UPC) for the treatment of adults with type 2 diabetes over a 6-month period. It was hypothesized that participants in the SMA will have greater reductions in A1C at 6 months post-intervention compared to the control group. METHODS: This study was a quasi-experimental design with a non-randomized matched control group that followed participants prospectively for 6 months. All adults living with type-2 diabetes receiving primary care at a 2 FQHC clinics were eligible for inclusion. Participants in the control group were matched retrospectively on baseline A1C and age. RESULTS: The reductions in A1C were greater in the ALDEA SMA intervention group relative to the UPC control group at 6 months in both of the FQHC centers and in the combined sample. CONCLUSIONS: This study demonstrated that patients in the ALDEA program had a significantly greater reduction in A1C at 6 months compared to the control group. Despite its limitations, the ALDEA SMA program was successful in empowering patients and improving glycemic control.

Implicit processing of emotional words by children with Post-Traumatic Stress Disorder: An fMRI investigation.

BACKGROUND/OBJECTIVE: In the last decade, socio-political violence in Colombia (South America) has created an environment of extreme/chronic stress. In this study, brain imaging technology (fMRI) and behavioral task performance were used to measure potential deficits in executive functioning for emotional processing in Colombian children. METHOD: Participants (22 Post-Traumatic Stress Disorder, PTSD and 22 neurotypical, NT) were asked to perform a word task with implicit emotional salience, which required them to report the color of the ink in which a positive, negative or neutral word was printed. RESULTS: Mixed design analysis of variance showed no group differences in accuracy for determining ink color when presented as a positive or neutral word. However, PTSD children were significantly less accurate (negative words) and notably slower (both positive and negative words) at determining ink color when presented in the context of an emotional word. PTSD processing of positive and negative words was associated with hypoactivation in the superior and middle frontal gyri of the right hemisphere in comparison to NT children. CONCLUSIONS: These results may reflect a deficit in executive functioning for emotionally laden stimuli, perhaps induced as a by-product of their traumatic experiences.

ANTECEDENTES/OBJETIVO: En la última década, la violencia socio-política en Colombia, ha propiciado un ambiente generador de situaciones de estrés crónico/extremo. El presente estudio empleó resonancia magnética funcional, junto con tareas conductuales, para medir posibles déficits en el funcionamiento ejecutivo en una tarea de palabras con contenido emocional en una muestra de niños colombianos. MÉTODO: A los participantes (22 TEPT y 22 controles), se les pidió indicar el color de la palabra impresa, omitiendo el contenido emocional implícito positivo, neutro o negativo. RESULTADOS: El análisis de varianza de diseño mixto, no arrojó diferencias entre los grupos, en número de aciertos al determinar el color en que estaban impresas las palabras positivas o neutras. Sin embargo, los niños con TEPT tuvieron más errores con las palabras de contenido emocional negativo y fueron más lentos que los controles con palabras de valencia positiva o negativa. En cuanto a las palabras positivas y negativas, el grupo con TEPT se asoció a hipoactivación de los giros superior y medio frontal del hemisferio derecho, al compararlos con los controles. CONCLUSIONES: Estos resultados sugieren déficits en el funcionamiento ejecutivo para estímulos con contenido emocional, quizás como consecuencia de las experiencias traumáticas vividas por el grupo de TEPT.