Barriers and Facilitators to Accessing PrEP and Other Sexual Health Services Among Immigrant Latino Men Who Have Sex with Men in Los Angeles County.

In the United States, immigrant Latino men who have sex with men (ILMSM) are, compared to white MSM, disproportionately burdened by HIV and lack access to highly effective HIV prevention strategies, such as pre-exposure prophylaxis (PrEP). Qualitative research centered on exploring barriers that ILMSM experience in accessing PrEP and other sexual services is extremely limited, despite a high prevalence of HIV in this population. In this study, a purposive sample of ILMSM (n = 25) was recruited to participate in a semi-structured in-depth interview to identify the distinct barriers and facilitators ILMSM experience in accessing sexual health services given their complex intersectional identities of being an immigrant, Latino, and a sexual minority man. Using a thematic analysis approach, nine themes were generated from the data representing barriers and facilitators. Barriers included: (1) cost and a lack of health insurance, (2) complexity of PrEP assistance programs; (3) challenges related to the immigrant experience; (4) impact of gay stigma; and (5) communication challenges. Facilitators included: (1) improving affordability and accessibility of PrEP services; (2) receiving services from LGBT- or Latine LGBT-centered clinics; (3) receiving services from medical providers who are gay and/or Latino; and (4) providing targeted community outreach, education, and promotion of PrEP to ILMSM. While many of the barriers illuminated in the study were structural (e.g., cost and lack of health insurance), and not easy to overcome, the findings highlight a range of facilitators that can support access to PrEP and other sexual health services for ILMSM. Considering these findings, we suggest strategies that may enhance access to needed sexual health services among ILMSM.

Social Outbreak in Chile, and Its Association with the Effects Biological, Psychological, Social, and Quality of Life.

The World Health Organization has defined collective violence as the instrumental use of violence by people who identify themselves as members of a group against other individuals and have political, economic, or social objectives. In Chile, the "Social Outbreak" was used to describe an episode of collective violence, which began on October 18, 2019, triggered by a multitude of socioeconomic and political factors, with protests and mobilizations in the country's large and small cities; in central, commercial, and residential areas, that lasted for several months, affecting a large part of the population. The objective of the present study was to associate the social outbreak in Chile with its biological, psychological, and social effects on people's health and quality of life, as well as its characteristics in terms of exposure, proximity, type, and frequency. This was a cross-sectional study with non-probabilistic national-level sampling, conducted from 28 November 2019, to 3 March 2020. The instrument had four sections. A total of 2651 participants answered the survey; 70.8% were female, and the mean age was 35.2. The main disturbances perceived were protests (70.9%), alarm sounds (68.1%), shooting sounds (59.0%), and tear gas bombs (56.9%). When quantifying the magnitude of these associations, people who had a medium exposure have a higher probability (OR: 1.99, CI: 1.58; 2.50) of suffering three or more biological effects than people that have a low exposure, while people with higher exposition have a 4.09 times higher probability (CI: 3.11; 5.38). A similar pattern was observed regarding psychological effects, although social effects were primarily experienced by those with high exposure. Social networks, TV, and radio were the most used media among people who perceived a greater effect. People who lived, worked, or shopped near the disturbance's areas show a higher proportion negative effect.

Maternal Psychosocial Stress Is Associated with Reduced Diversity in the Early Infant Gut Microbiome.

The developing infant gut microbiome is highly sensitive to environmental exposures, enabling its evolution into an organ that supports the immune system, confers protection from infection, and facilitates optimal gut and central nervous system function. In this study, we focus on the impact of maternal psychosocial stress on the infant gut microbiome. Forty-seven mother-infant dyads were recruited at the HEAL Africa Hospital in Goma, Democratic Republic of Congo. Extensive medical, demographic, and psychosocial stress data were collected at birth, and infant stool samples were collected at six weeks, three months, and six months. A composite maternal psychosocial stress score was created, based on eight questionnaires to capture a diverse range of stress exposures. Full-length 16S rRNA gene sequences were generated. Infants of mothers with high composite stress scores showed lower levels of gut microbiome beta diversity at six weeks and three months, as well as higher levels of alpha diversity at six months compared to infants of low stress mothers. Longitudinal analyses showed that infants of high stress mothers had lower levels of health-promoting Lactobacillus gasseri and Bifidobacterium pseudocatenulatum at six weeks compared to infants of low stress mothers, but the differences largely disappeared by three to six months. Previous research has shown that L. gasseri can be used as a probiotic to reduce inflammation, stress, and fatigue, as well as to improve mental state, while B. pseudocatenulatum is important in modulating the gut-brain axis in early development and in preventing mood disorders. Our finding of reduced levels of these health-promoting bacteria in infants of high stress mothers suggests that the infant gut microbiome may help mediate the effect of maternal stress on infant health and development.

Prefrontal Cortical Control of Activity in Nucleus Accumbens Core Is Weakened by High-Fat Diet and Prevented by Co-Treatment with N-Acetylcysteine: Implications for the Development of Obesity.

A loss of neuroplastic control on nucleus accumbens (NAc) neuronal activity exerted by the medial prefrontal cortex (mPFC) through long-term depression (LTD) is involved in triggering drug-seeking behavior and relapse on several substances of abuse due to impaired glutamate homeostasis in tripartite synapses of the nucleus accumbens (NAc) core. To test whether this maladaptive neuroplastic mechanism underlies the addiction-like behavior induced in young mice by a high-fat diet (HFD), we utilized 28-days-old male mice fed HFD ad-libitum over 2 weeks, followed by 5 days of HFD abstinence. Control groups were fed a regular diet. HFD fed mice showed increased ΔFosB levels in the NAc core region, whereas LTD triggered from the mPFC became suppressed. Interestingly, LTD suppression was prevented by an i.p. injection of 100 mg/kg N-acetylcysteine 2.5 h before inducing LTD from the mPFC. In addition, excessive weight gain due to HFD feeding was diminished by adding 2mg/mL N-acetylcysteine in drinking water. Those results show a loss of neuroplastic mPFC control over NAc core activity induced by HFD consumption in young subjects. In conclusion, ad libitum consumption of HFD can lead to neuroplastic changes an addiction-like behavior that can be prevented by N-acetylcysteine, helping to decrease the rate of excessive weight gain.

NMDA and P2X7 Receptors Require Pannexin 1 Activation to Initiate and Maintain Nociceptive Signaling in the Spinal Cord of Neuropathic Rats.

Pannexin 1 (Panx1) is involved in the spinal central sensitization process in rats with neuropathic pain, but its interaction with well-known, pain-related, ligand-dependent receptors, such as NMDA receptors (NMDAR) and P2X7 purinoceptors (P2X7R), remains largely unexplored. Here, we studied whether NMDAR- and P2X7R-dependent nociceptive signaling in neuropathic rats require the activation of Panx1 channels to generate spinal central sensitization, as assessed by behavioral (mechanical hyperalgesia) and electrophysiological (C-reflex wind-up potentiation) indexes. Administration of either a selective NMDAR agonist i.t. (NMDA, 2 mM) or a P2X7R agonist (BzATP, 150 µM) significantly increased both the mechanical hyperalgesia and the C-reflex wind-up potentiation, effects that were rapidly reversed (minutes) by i.t. administration of a selective pannexin 1 antagonist (10panx peptide, 300 µM), with the scores even reaching values of rats without neuropathy. Accordingly, 300 µM 10panx completely prevented the effects of NMDA and BzATP administered 1 h later, on mechanical hyperalgesia and C-reflex wind-up potentiation. Confocal immunofluorescence imaging revealed coexpression of Panx1 with NeuN protein in intrinsic dorsal horn neurons of neuropathic rats. The results indicate that both NMDAR- and P2X7R-mediated increases in mechanical hyperalgesia and C-reflex wind-up potentiation require neuronal Panx1 channel activation to initiate and maintain nociceptive signaling in neuropathic rats.

Comparison of shear bond strength of metal orthodontic brackets bonded to a CAD/CAM prosthetic provisional material after the use of a self-adhesive resin cement versus a light adhesive paste and different surface conditioning protocols: An in vitro study.

BACKGROUND: Adult orthodontic treatment has been increasingly popular, and brackets may need to be bonded to provisional crowns, including CAD/CAM crowns. The use of self-adhesive resin cement or light adhesive paste have been suggested with different surface conditioning protocols to improve the adhesion to CAD/CAM PMMA provisional crowns. Objective To determine and compare the in vitro shear bond strength (SBS) of metal brackets bonded to a provisional prosthetic CAD/CAM material after the use of different adhesive cements and surface conditioning protocols. MATERIALS AND METHODS: One hundred twenty Telio® CAD specimens were manufactured in 12 groups (n=10). Each specimen was bonded to a metal bracket and divided according to adhesive technique (3M™Transbond™ XT Light Cure Paste or 3M™RelyX™ U200) surface treatment (macroretentions) and the use of silane. Half of the specimens were thermocycled (5000 cycles, 5°C/55°C water baths). The SBS test was carried out using a shear bond strength tester, and the type of adhesive failure was determined by means of the adhesive remnant index. The data were analysed with the Mann-Whitney test (α=0.05). RESULTS: Statistically significant differences (P<0.001) in SBS were found among the groups. The group with macroretentions, silane, and not thermocycled was the one that obtained the highest average value (17.31±4.89MPa). The lowest average value was the group without macroretentions, without silane, and thermocycled (3.4±3.37MPa). CONCLUSION: The shear bond strength of brackets to provisional prosthetic CAD/CAM materials depended on the type of adhesive, surface treatment, and aging by thermocycling.

Therapist challenges and client responses in psychodynamic psychotherapy: An empirically supported case study.

In this case study of an adult female client working with a doctoral student female therapist in 85 sessions of individual psychodynamic psychotherapy, we analyzed the antecedents, challenges, and consequences for 53 challenges in the intake and first five sessions, the middle three sessions, and the final three sessions. Within the context of a strong therapeutic relationship and when the client was balanced in being defended as well as open/reflective, the therapist's challenges that were of high quality (deep, clear, empathic, and moderately forceful) were associated with the client becoming more open/reflective. In contrast, when the client was defended (but not open/reflective), the therapist's challenges were of lower quality and were associated with the client becoming more defended and closed off. Thus, both the antecedent client state and the quality of the therapist challenges were associated with the consequences of challenges in terms of the client's response. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Silence is golden: A mixed methods investigation of silence in one case of psychodynamic psychotherapy.

We investigated the antecedents, occurrences, and consequences of 183 silence events in the first 5 and last 5 sessions of a 73-session case of successful psychodynamic psychotherapy. Silences generally occurred within client speaking turns, such that the client often paused to reflect while speaking. In the last 5 sessions, as compared with the first 5 sessions, the client was more collaborative before and after silences, silences were shorter, the therapist was more connectional during silences (e.g., shared emotion and meaning with client), and the client was more emotional after silences. Antecedent client collaboration, duration of the silence, therapist behavior during silence events, client behavior during silence events, and who broke the silence all related to change in collaboration from before to after the silence events. We concluded that silence was helpful in this case because of client factors (the client naturally paused a lot during discussion, the client was quite reflective and insightful), therapist factors (the therapist was comfortable with and believed in silence), and relationship factors (there was a strong therapeutic relationship). (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Therapist effects due to client racial/ethnic status when examining linear growth for client- and therapist-rated working alliance and real relationship.

Using data from 3,263 sessions nested within 144 clients, nested within 19 therapists, we examined client- and therapist-rated working alliance (WA) and real relationship (RR) at Session 3 and growth in WA and RR across the course of open-ended psychodynamic psychotherapy for clients who identified as racial/ethnic minority (REM) or as White. To be included in the analyses, therapists had to work with at least 2 REM and 2 White clients. There were no significant therapist effects for the interaction between client- or therapist-rated WA and client REM status at Session 3, or for client- or therapist-rated RR and client REM status at Session 3. There were, however, significant therapist effects due to client REM status on the interaction between client-rated linear growth in WA and RR, showing that some therapists had stronger WA and RR growth with REM than that with White clients, whereas other therapists had stronger alliance growth with White than that with REM clients. There were significant therapist effects on therapist-rated linear growth in both WA and RR, which indicated that some therapists reported stronger WA and RR growth with all of their clients, whereas other therapists reported weaker WA and RR growth for all of their clients, although this differential WA and RR growth was not related to clients' REM status. Implications for practice and research are discussed in this paper. (PsycINFO Database Record

Calidad metodológica de ensayos clínicos sobre periodoncia publicados en revistas ISI / Methodological quality of periodontal clinical trials published in ISI Journals

Describir la calidad metodológica de los ensayos clínicos de periodoncia en revistas indexadas en el Institute for Scientific Information. Material y métodos: Estudio observacional descriptivo en el que se evaluaron los ensayos clínicos publicados entre Enero de 2008 y Diciembre de 2012, de las cuatro revistas de periodoncia indexadas a ISI, con mayor factor de impacto en los últimos 5 años según Journal Citation Reports. Se realizó una estrategia de búsqueda en PubMed para cada revista. Sólo los ensayos clínicos fueron seleccionados para el análisis cualitativo por medio de una escala de calidad metodológica. Los datos fueron analizados utilizando el paquete estadístico SPSS Statistics 20 para Windows (IBM., Chicago, USA.) y presentados mediante estadística descriptiva. Resultados: De las revistas que cumplieron los criterios de selección, Journal of Clinical Periodontology, Journal of Periodontology, Journal of Periodontal Research e International Journal of Periodontics & Restorative Dentistry, se analizaron 387 ensayos clínicos. De los 24 puntos máximos obtenibles de la escala, la media alcanzada por los manuscritos evaluados fue de 17,45 puntos. Conclusión: La calidad metódológica de los ensayos clínicos en periodoncia, indexados en revistas ISI, fue deficiente...

To describe the methodological quality of periodontal clinical trials in journals indexed by the Institute for Scientific Information (ISI).Materials and methods: Descriptive observational study in which the clinical trials published in four ISI-indexed periodontics journals between January 2008 and December 2012 were evaluated. The journals were selected as they had had the highest impact factor in the last 5 years according to the Journal Citation Reports.For each journal, papers were searched for in PubMed. Only clinical trials were selected to conduct the qualitative analysis using a methodological quality scale. Statistical analysis was conducted with SPSS Statistics 20 for Windows (IBM, Chicago, USA), and the data were presented through descriptive statistics. Results: The following journals fulfilled the selection criteria: Journal of Clinical Periodontology, Journal of Periodontology, Journal of Periodontal Research and International Journal of Periodontics & Restorative Dentistry. From these journals, 387 clinical trials were analyzed. Of the maximum of 24 points in the scale, the mean reached was 17.45 points. Conclusion: The methodological quality of periodontal clinical trials indexed in ISI is deficient...

Multidisciplinary team review of best practices for collection and handling of blood cultures to determine effective interventions for increasing the yield of true-positive bacteremias, reducing contamination, and eliminating false-positive central line-associated bloodstream infections.

BACKGROUND: A literature search was conducted using keywords for articles published in English from January 1990 to March 2015. Using criteria related to blood culture collection and handling, the search yielded 101 articles. References used also included Microbiology Laboratory standards, guidelines, and textbook information. RESULTS: The literature identified diverse and complex issues surrounding blood culture practices, including the impact of false-positive results, laboratory definition of contamination, effect on central line-associated bloodstream infection (CLABSI) reporting, indications for collecting blood cultures, drawing from venipuncture sites versus intravascular catheters, selection of antiseptics, use of needleless connectors, inoculation of blood culture bottles, and optimizing program management in emergency departments, education, and implementation of bundled practice initiatives. CONCLUSION: Hospitals should optimize best practice in the collection, handling, and management of blood culture specimens, an often overlooked but essential component in providing optimal care of patients in all settings and populations, reducing financial burdens, and increasing the accuracy of reportable CLABSI. Although universal concepts exist in blood culture practices, some issues require further research to determine benefit. Institutions undertaking a review of their blood culture programs are encouraged to use a checklist that addresses elements that encompass the research contained in this review.

Comparación de tres métodos de toma de Papanicolaou / Comparision of three methods of taking Papanicolaou samples

El Pap es uno de los métodos más baratos y eficaces en la detección precoz del cáncer cérvico uterino. Para que se cumpla su objetivo es necesario que se tome con periodicidad y que la muestra sea representativa. El propósito del trabajo es comparar 3 métodos de toma de Pap: M1: espátula de Ayre (EA) más tórula de algodón (aplicador), M2: EA más cepillo endocervical y M3: EA más pipeta de aspiración. Además quisimos ver la influencia del factor humano pues es el tomador de la muestra (TM) el que influye en que ésta sea adecuada