Effectiveness of a Digital Health Intervention Leveraging Reinforcement Learning: Results From the Diabetes and Mental Health Adaptive Notification Tracking and Evaluation (DIAMANTE) Randomized Clinical Trial.

BACKGROUND: Digital and mobile health interventions using personalization via reinforcement learning algorithms have the potential to reach large number of people to support physical activity and help manage diabetes and depression in daily life. OBJECTIVE: The Diabetes and Mental Health Adaptive Notification and Tracking Evaluation (DIAMANTE) study tested whether a digital physical activity intervention using personalized text messaging via reinforcement learning algorithms could increase step counts in a diverse, multilingual sample of people with diabetes and depression symptoms. METHODS: From January 2020 to June 2022, participants were recruited from 4 San Francisco, California-based public primary care clinics and through web-based platforms to participate in the 24-week randomized controlled trial. Eligibility criteria included English or Spanish language preference and a documented diagnosis of diabetes and elevated depression symptoms. The trial had 3 arms: a Control group receiving a weekly mood monitoring message, a Random messaging group receiving randomly selected feedback and motivational text messages daily, and an Adaptive messaging group receiving text messages selected by a reinforcement learning algorithm daily. Randomization was performed with a 1:1:1 allocation. The primary outcome, changes in daily step counts, was passively collected via a mobile app. The primary analysis assessed changes in daily step count using a linear mixed-effects model. An a priori subanalysis compared the primary step count outcome within recruitment samples. RESULTS: In total, 168 participants were analyzed, including those with 24% (40/168) Spanish language preference and 37.5% (63/168) from clinic-based recruitment. The results of the linear mixed-effects model indicated that participants in the Adaptive arm cumulatively gained an average of 3.6 steps each day (95% CI 2.45-4.78; P<.001) over the 24-week intervention (average of 608 total steps), whereas both the Control and Random arm participants had significantly decreased rates of change. Postintervention estimates suggest that participants in the Adaptive messaging arm showed a significant step count increase of 19% (606/3197; P<.001), in contrast to 1.6% (59/3698) and 3.9% (136/3480) step count increase in the Random and Control arms, respectively. Intervention effectiveness differences were observed between participants recruited from the San Francisco clinics and those recruited via web-based platforms, with the significant step count trend persisting across both samples for participants in the Adaptive group. CONCLUSIONS: Our study supports the use of reinforcement learning algorithms for personalizing text messaging interventions to increase physical activity in a diverse sample of people with diabetes and depression. It is the first to test this approach in a large, diverse, and multilingual sample. TRIAL REGISTRATION: ClinicalTrials.gov NCT03490253; https://clinicaltrials.gov/study/NCT03490253. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.1136/bmjopen-2019-034723.

Evaluation of a pilot implementation of a digital cognitive behavioral therapy platform for isolated older adults in county mental health services.

Background: Technology-enabled services (TESs) have the potential to increase access to mental healthcare. However, little research has focused on how TESs can be integrated into publicly funded service settings. As part of the state-wide Help@Hand project, Marin County conducted a pilot implementation of myStrength, a digital cognitive behavioral therapy platform, to explore its potential to reduce loneliness among isolated older adults. We evaluated the pilot impact using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. Method: A single-site 6-month pilot implementation recruited English (n = 15) and Spanish-speaking (n = 15) isolated older adults who received a digital literacy course followed by 8 weeks of myStrength access and human support. We evaluated factors related to reach, effectiveness, adoption, and implementation using the perspectives of users and County staff. Descriptive statistics were used to examine reach, adoption, and implementation. Nonparametric tests, including Friedman and Wilcoxon signed-rank, were used to examine effectiveness. Results: Reach: Compared to overall county demographics, platform users were majority female (93.1% vs. 50.5%), ethnoracialized (62.1% vs. 24.2%), and of lower socioeconomic status (Mdn = $35,000 vs. $131,008). Effectiveness: Users reported a significant (z = -2.62, p < .001) decrease in loneliness. Adoption: Users logged into myStrength an average of 10 times and completed 33 activities during the 8 weeks of myStrength use. Implementation: Each pilot staff (N = 20) spent an average of 19.8 hr (SD = 16.51) supporting users' use of myStrength during the pilot. Pilot staff reported several adaptations to meet the needs of users. Conclusions: Successes included reaching the target population, reducing loneliness, and user adoption. However, pilot staff invested significant time to support those with lower digital literacy skills. As such, although TESs may address unmet needs, their use with underserved populations may require upfront and ongoing support provided by the settings where they are implemented. Plain Language Summary Title: Testing a New Digital Therapy Tool for Isolated Older Adults in County Mental Health Services.

This paper reports on the use of digital tools to support needs in publicly funded mental healthcare. In 2021, Marin County piloted a program involving the use of myStrength, a digital cognitive-behavioral therapy (dCBT) platform, with human support provided by a nurse intern or promotores. Although several studies have demonstrated that dCBT can be effective, few studies have evaluated this in real-world settings or considered issues related to its implementation. As such, although dCBT can provide benefit to people, less is known about how to deploy it, especially in diverse contexts and populations. This project specifically focused on reducing loneliness among isolated older adults, including both English and Spanish speakers. This paper adds valuable insights by demonstrating that the project successfully reached the target population, reduced loneliness, and achieved high user adoption rates. It also identified challenges, including low digital literacy skills among the target populations and the need for substantial upfront and ongoing support. The findings suggest that the combination of dCBT and human support holds promise in addressing unmet mental health needs, especially among vulnerable populations. At the same time, the implementation of these services in such contexts demands substantial resources and support, especially to bridge the digital literacy gap. These implications have practical significance for practitioners, researchers, and policymakers, emphasizing the importance of tailored support mechanisms when deploying digital tools in publicly funded service settings to ensure equitable access and effectiveness.

State of the Science: Using Digital Mental Health Interventions to Extend the Impact of Psychological Services.

In recent years, digital mental health interventions (DMHIs) have emerged as a paradigm shift in care delivery that could expand the scale, efficiency, and effectiveness of psychological services. However, DMHI impact is constrained by issues related to limited reach, poor adoption, implementation barriers, and insufficient long-term maintenance. Organized by the Reach, Effectiveness, Adoption, Implementation, and Maintenance(RE-AIM) framework, this paper surveys the current state of DMHIs, highlighting research and practice gaps as well as potential strategies to move the field forward. Similarly, we discuss the role that emerging technologies and changes in the profession will play in shaping DMHIs in years to come. Finally, concrete and actionable steps to advance equity in the DMHI field are provided, with an emphasis on strategies to increase the representativeness of marginalized populations in DMHI research, the inclusion of these groups in the design and testing of DMHIs, and how to improve the contextual and cultural fit of DMHIs.

Comparison of efficacy and safety of the new generation helixone dialyzers.

INTRODUCTION: New generation helixone dialyzers has recently been developed as part of the ongoing effort to improve dialyzer hemocompatibility and avoid adverse reactions to synthetic dialyzers. This study aimed to assess the performance and albumin loss of this new dialyzer series in hemodiafiltration and compare it with the previous generation helixone series. MATERIAL AND METHODS: A prospective study was conducted in 19 patients. Each patient underwent eight dialysis sessions with the same routine dialysis parameters; only the dialyzer varied: FX60 CorDiax, FX CorAL 60, FX600 CorDiax, FX CorAL 600, FX80 CorDiax, FX CorAL 80, FX800 CorDiax, and FX CorAL 800. The reduction ratios (RR) of urea, creatinine, ß2-microglobulin, myoglobin, kappa-free immunoglobulin light chains (κFLC), prolactin, α1-microglobulin, α1-acid glycoprotein, lambda immunoglobulin light chains (λFLC), and albumin were compared intra-individually. Dialysate albumin loss was also measured. RESULTS: All treatments were well tolerated. The mean amount of replacement fluid ranged from 31 to 34 L. Comparison of dialysis treatments showed no differences between small molecules and even up to those the size of ß2-microglobulins. Little differences were found between myoglobin, κFLC, prolactin, α1-microglobulin, and λFLC RRs, and only FX80 CorDiax was slightly superior to the others. Mean dialysate albumin losses were similar, with less than 2.5 g lost in each dialyzer. The FX80 CorDiax showed slightly higher global removal scores than the other dialyzers evaluated, except for FX CorAL 800. CONCLUSION: The new generation helixone dialyzers series has been updated to minimise the risk of adverse reactions, while maintaining the effectiveness and albumin loss achieved by the previous most advanced helixone generation.

Identifying potential predictable indicators for the management of tertiary hospitals.

BACKGROUND: The European University Hospitals Alliance (EUHA) recognises the need to move from the classical approach of measuring key performance indicators (KPIs) to an anticipative approach based on predictable indicators to take decisions (Key Decision Indicators, KDIs). It might help managers to anticipate poor results before they occur to prevent or correct them early. OBJECTIVE: This paper aims to identify potential KDIs and to prioritize those most relevant for high complexity hospitals. METHODS: A narrative review was performed to identify KPIs with the potential to become KDIs. Then, two surveys were conducted with EUHA hospital managers (n = 51) to assess potential KDIs according to their relevance for decision-making (Value) and their availability and effort required to be predicted (Feasibility). Potential KDIs are prioritized for testing as predictable indicators and developing in the short term if they were classified as highly Value and Feasible. RESULTS: The narrative review identified 45 potential KDIs out of 153 indicators and 11 were prioritized. Of nine EUHA hospitals, 25 members from seven answered, prioritizing KDIs related to the emergency department (ED), hospitalisation and surgical processes (n = 8), infrastructure and resources (n = 2) and health outcomes and quality (n = 1). The highest scores in this group were for those related to ED. The results were homogeneous among the different hospitals. CONCLUSIONS: Potential KDIs related to care processes and hospital patient flow was the most prioritized ones to test as being predictable. KDIs represent a new approach to decision-making, whose potential to be predicted could impact the planning and management of hospital resources and, therefore, healthcare quality.

Effectiveness-implementation hybrid trial of Spanish language, digital cognitive-behavioral therapy (dCBT) intervention for depression and anxiety - protocol for the SUPERA (SUpport from PEeRs to expand Access) study.

BACKGROUND: Limited English Proficiency (LEP) Latinxs experience a longer duration of untreated depression and anxiety. LEP Latinxs have difficulty accessing mental healthcare due to insufficient Spanish-speaking behavioral/mental health clinicians to meet demand. These under-resourced healthcare systems are less likely to be the site for the implementation of innovations. Digital interventions can provide an effective option for overcoming these barriers; yet, when digital evidence-based treatments are available, uptake and engagement is often low. This manuscript presents the protocol for the SUPERA (SUpport from PEeRs to expand Access) study which will evaluate the implementation of an evidence-based, Spanish language, digital cognitive-behavioral therapy (dCBT) intervention (i.e., SilverCloud) in safety-net primary care clinics for LEP Latinx patients with depression or anxiety. METHODS: We will conduct an effectiveness-implementation hybrid trial (Type 2) design comparing engagement and clinical outcomes in two modalities of dCBT delivery (peer-supported vs. unsupported). We will also compare provider-level outreach (using a clinic patient registry) versus inreach (traditional provider referral) to compare rates of initiation, completion, and cost. Participants will be 426 LEP Latinx adults ≥18 years of age, PHQ-9 ≥ 10 or GAD-7 ≥ 8, with access to the internet via smartphone, and not currently receiving individual psychotherapy. We will collect baseline, post-intervention (8 weeks), and follow up (3 months) data. CONCLUSION: The long-term goal of this research is to aid in the implementation of digital mental health interventions that can be sustainably implemented in low-resourced settings, while reducing the reliance on professionals, overcoming workforce deficits, and increasing relevance for diverse populations.

Prevalencia y severidad de la caries dental en adolescentes / Prevalence and Severity of Dental Cavities in Adolescents

Introducción: La caries dental es una enfermedad multifactorial que prevalece durante la infancia y adolescencia. Objetivo: Determinar la prevalencia, severidad y gravedad de la caries dental en los adolescentes. Métodos: Se realizó un estudio descriptivo de corte transversal en adolescentes pertenecientes al municipio Plaza de la Revolución, La Habana, Cuba, en el período de octubre de 2019 a octubre de 2022. La muestra que se empleó fue de tipo aleatoria estratificada de 969 adolescentes. Para medir la prevalencia de la caries se utilizó el COP-D, para la severidad y gravedad el sistema ICDAS. Los datos primarios se procesaron con los programas informáticos Statistica 6.1. Se realizó prueba de ji al cuadrado por el programa Epidat y los resultados se describieron mediante cifras frecuenciales y porcentuales. Resultados : El índice de COP-D fue de 1,92; en el grupo de 18-19 años el COP-D fue de 1,96. Con relación a la severidad de las caries, el 19,2 por ciento presentó caries código 1; el grupo de 18-19 años mostró un 18,9 por ciento de afectación por caries, relacionadas con la gravedad de las lesiones; los mayores porcentajes se presentaron en las lesiones leves con un 35,2 por ciento. Conclusiones: La prevalencia de la caries dental fue baja. El índice de COP-D ligeramente mayor en el grupo de 18-19 años. En cuanto a la severidad, predominaron las lesiones de caries código 1 y 2; las mayores proporciones fueron leves(AU)

Introduction: Dental cavities is a multifactorial disease prevalent during childhood and adolescence. Objective: To determine the prevalence and severity of dental cavities in adolescents. Methods: A descriptive cross-sectional study was carried out in adolescents belonging to the Plaza de la Revolución municipality, Havana, Cuba, in the period from October 2019 to October 2022. The sample used was a stratified random sample of 969 adolescents. The COP-D was used to measure the prevalence of cavities, and the ICDAS system was used for severity and severity. The primary data were processed with Statistica 6.1 software. The chi-square test was performed with the Epidat program and the results were described by frequency and percentage figures. Results: The COP-D index was 1.92; in the group aged 18-19 years the COP-D was 1.96. In relation to cavities severity, 19.2 percent presented code 1 cavities; the 18-19 years age group showed 18.9 percent cavities involvement, related to the severity of the lesions; the highest percentages were presented in mild lesions with 35.2 percent. Conclusions: The prevalence of dental cavities was low. The rate of COP-D was slightly higher in the 18-19 years age group. In terms of severity, cavities code 1 and 2 lesions predominated; the highest proportions were mild(AU)

Videodeglución: un estudio siempre actual que nunca envejece. Técnica y aplicación en la práctica diaria / Videodeglution: an up-to-date study that never gets old. Technique and application in daily practice

Resumen La videodeglución es un estudio fisiológico y en tiempo real que, al momento, no tiene reemplazo por otra modalidad. Ofrece información relevante sobre el sistema estomatognático del paciente, así como sobre la estructura y la funcionalidad orofaríngea y esofágica. Este estudio cuenta con distintas fases (oral, faríngea y esofágica) en las que se analizan diversas estructuras, así como la funcionalidad de estas a través de degluciones inducidas de diferentes consistencias (semisólido, líquido, sólido). Las patologías que pueden encontrarse son múltiples, siendo algunas de las más frecuentes la disfunción del músculo cricofaríngeo, la penetración/aspiración en la vía aérea, los divertículos y la acalasia. Resulta fundamental su ejecución con una técnica correcta, conociendo previamente la sintomatología, el motivo por el cual fue indicada, la anatomía de las estructuras/cavidades y la fisiología de la deglución. Por lo tanto, una adecuada técnica en la ejecución de la videodeglución y el conocimiento preliminar de la anatomía y la fisiología, así como de los hallazgos y patologías más frecuentes, son fundamentales para una adecuada evaluación del paciente y una correcta interpretación de las imágenes.

Abstract Video swallowing is a physiological and real-time study that, at the moment, cannot be replaced by another modality. It offers relevant information about the patient's stomatognathic system, as well as the oropharyngeal and esophageal structure and function. This study has different phases (oral, pharyngeal and esophageal) where various structures are analyzed, as well as their functionality through induced objects of different consistencies (semi-solid, liquid and solid). The pathologies that can be found are multiple, some of the most frequent being dysfunction of the cricopharyngeal muscle, penetration/aspiration into the airway, diverticula and achalasia. Its execution with a correct technique is fundamental, knowing previously the symptomatology, reason for which it was indicated, the anatomy of the structures/cavities and the physiology of swallowing. Therefore, an adequate technique in the execution of video swallowing and preliminary knowledge of anatomy and physiology, as well as the most frequent findings and pathologies, are fundamental for a correct evaluation of the patient and interpretation of the images.

Contrast-enhanced Mammography Artifacts and Pitfalls: Tips and Tricks to Avoid Misinterpretation.

Contrast-enhanced mammography (CEM) involves addition of intravenous iodinated contrast material at digital mammography, thus increasing the ability to detect breast cancer owing to tumor contrast enhancement. After image acquisition, interpretation includes careful assessment of the technique, artifacts, and pitfalls and reporting with a standard lexicon category and appropriate follow-up recommendations. Artifacts and pitfalls that may cause image misinterpretation should be detected and distinguished from pathologic conditions. Different artifacts apparent on CEM images are usually caused during image acquisition and include CEM-specific and contrast agent-related artifacts, apart from the typical digital mammography artifacts. The pitfalls are related to technical and diagnostic difficulties. One disadvantage of CEM that MRI does not have is a technical factor related to a mammography technique that consists of blind spots that may not be included in the imaging field of mammography views, including the axilla, medial region of the breast, or areas close to the breast wall. Normal breast tissue enhancement called background parenchymal enhancement is also present at CEM and may affect interpretation performance. Diagnostic pitfalls are caused by minimally enhancing lesions, such as invasive lobular carcinomas and mucinous carcinomas, which are difficult to detect with CEM, resulting in false-negative findings. Benign lesions can show enhancement at CEM and represent false-positive lesions that should also be recognized. The authors discuss image interpretation of CEM studies and focus on the artifacts and pitfalls that may be encountered. ©RSNA, 2023 Quiz questions for this article are available in the supplemental material.

The Past, Present, and Future of Psychotherapy Manuals: Protocol for a Scoping Review.

BACKGROUND: Psychotherapy manuals are critical to the dissemination of psychotherapy treatments. Psychotherapy manuals typically serve several purposes, including, but not limited to, establishing new psychotherapy treatments, training providers, disseminating treatments to those who deliver them, and providing guidelines to deliver treatments with fidelity. Yet, the proliferation of psychotherapy manuals has not been well-understood, and no work has aimed to assess or review the existing landscape of psychotherapy manuals. Little is known about the breadth, scope, and foci of extant psychotherapy manuals. OBJECTIVE: This scoping review aims to identify and explore the landscape of existing book-based psychotherapy manuals. This review aims to specify the defining characteristics (ie, foci, clinical populations, clinical targets, treatment type, treatment modality, and adaptations) of existing book-based psychotherapy manuals. Further, this review will demonstrate how this information, and psychotherapy manuals more broadly, has changed over time. This project aims to make a novel contribution that will have critical implications for current methods of developing, aggregating, synthesizing, and translating knowledge about psychotherapeutic treatments. METHODS: This scoping review will review book-based psychotherapy manuals published from 1950 to 2022.This scoping review will be informed by guidance from the Joanna Briggs Institute Scoping Review Methodology Group and prior scoping reviews. Traditional search and application programming interface-based search methods will be used with search terms defined a priori to identify relevant results using 3 large book databases: Google Books, WorldCat, and PsycINFO. This review will leverage machine learning methods to enhance and expedite the screening process. Primary screening of results will be conducted by at least 2 authors. Data will be extracted and double-coded by research assistants using an iteratively defined codebook. RESULTS: The search process produced 78,600 results, which were then iteratively deduplicated. Following deduplication, 50,583 results remained. The scoping review is expected to identify common elements of psychotherapy manuals, establish how the foci and content of manuals have changed over time, and illustrate coverage and gaps in the landscape of psychotherapy manuals. Results from this scoping review will be critical for future work focused on developing, aggregating, synthesizing, and disseminating knowledge about psychotherapeutic treatments. CONCLUSIONS: This review will provide knowledge about the vast landscape of psychotherapy manuals that exist. Findings from this study will inform future efforts to develop, aggregate, synthesize, and translate knowledge about psychotherapeutic treatments. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/47708.

Manifestaciones orales de la infección por COVID-19

Las secuelas y consecuencias de la COVID-19 son múltiples y engloban disímiles aspectos, con gran impacto negativo para los sistemas sanitarios y la humanidad. En tal sentido, poseer información actualizada y pertinente favorece al arduo enfrentamiento a esta pandemia. Este trabajo tiene el propósito de actualizar los conocimientos sobre las manifestaciones orales de la infección por COVID-19. A propósito de este tema, se realizó una revisión bibliográfica. La búsqueda se ejecutó a través de Google Académico, SciELO y otras fuentes de información de la Biblioteca Virtual de Salud de Cuba. El impacto de la COVID-19 en la salud oral está determinado por el sistema inmunológico del paciente, la farmacoterapia que recibe y la patogenia del virus. Predominan los síntomas de sequedad de boca, hipogeusia, disgeusia y ageusia, incluso antes de los síntomas respiratorios. Entre otras manifestaciones se encuentra la candidiasis orofaríngea, presente en aproximadamente el 5 % de los pacientes en días posteriores al diagnóstico. Las principales manifestaciones orales relacionadas a la COVID-19 reportadas en la literatura son: hiposalivación, xerostomía, ageusia, hipogeusia, disgeusia, lesiones herpéticas y candidiasis.

The aftereffect and consequences of COVID-19 are multiple and include dissimilar aspects, with a great negative impact on health systems and humanity. In this sense, having updated and relevant information favors the arduous confrontation with this pandemic. The purpose of this research is updating knowledge about the oral manifestations of COVID-19 infection. A bibliographical review was carried out. The search was carried out through Google Scholar, SciELO and other information sources from the Cuba Virtual Health Library. The impact of COVID-19 on oral health is determined by the patient's immune system, the pharmacotherapy they receive, and the pathogenesis of the virus. Symptoms of dry mouth, hypogeusia, dysgeusia, and ageusia predominate, even before respiratory symptoms. Other manifestations include oropharyngeal candidiasis; appear approximately in 5% of patients, days after diagnosis. The main oral manifestations related to COVID-19 reported in the literature are: hyposalivation, xerostomia, ageusia, hypogeusia, dysgeusia, herpetic lesions, and candidiasis.

NORMAL VALUES OF ESOPHAGEAL 24-HOUR IMPEDANCE-PH AMBULATORY IN AN ARGENTINE COHORT OF HEALTHY VOLUNTEERS.

BACKGROUND: There are no data of reference values on 24-hour multichannel intraluminal impedance and pH (pH-MII) monitoring in Argentinian populations. OBJECTIVE: Our aim was to obtain the normal values of pH-MII variables among healthy asymptomatic volunteers in a metropolitan Health Care Center of Argentina, and to compare them with data already published from other regions around the world. METHODS: A cross-sectional study was undertaken in a tertiary referral center in Buenos Aires. We enrolled healthy subjects and asked them to undergo esophageal pH-MII 24hours monitoring. pH-MII variables were recorded and described. RESULTS: Median reflux events was 20.5 (25-75%, 95%) interquartile range: (14-46, 50) and proximal reflux episodes was 2.5 (0-10, 11). Sixty percent were acid reflux episodes: 12 (5-29, 38), representing a relatively low value when compared to those reported in European, American and Chinese populations. CONCLUSION: Our study shows the first reference of normal values of gastroesophageal reflux in an Argentinian population. We found a total number of reflux events and a total number of proximal reflux events lower than what was reported until this date by other authors.

Valores normais de impedância-pHmetria de 24 horas em uma coorte de voluntários saudáveis na Argentina / Normal values of esophageal 24-hour impedance-ph ambulatory in an argentine cohort of healthy volunteers

ABSTRACT Background There are no data of reference values on 24-hour multichannel intraluminal impedance and pH (pH-MII) monitoring in Argentinian populations. Objective Our aim was to obtain the normal values of pH-MII variables among healthy asymptomatic volunteers in a metropolitan Health Care Center of Argentina, and to compare them with data already published from other regions around the world. Methods A cross-sectional study was undertaken in a tertiary referral center in Buenos Aires. We enrolled healthy subjects and asked them to undergo esophageal pH-MII 24hours monitoring. pH-MII variables were recorded and described. Results Median reflux events was 20.5 (25-75%, 95%) interquartile range: (14-46, 50) and proximal reflux episodes was 2.5 (0-10, 11). Sixty percent were acid reflux episodes: 12 (5-29, 38), representing a relatively low value when compared to those reported in European, American and Chinese populations. Conclusion Our study shows the first reference of normal values of gastroesophageal reflux in an Argentinian population. We found a total number of reflux events and a total number of proximal reflux events lower than what was reported until this date by other authors.

RESUMO Contexto Não há dados de valores de referência sobre o monitoramento de impedância intraluminal multicanal 24 horas e monitoramento de pH (pH-MII) em populações argentinas. Objetivo O objetivo foi obter os valores normais das variáveis pH-MII entre voluntários assintomáticos saudáveis em um centro metropolitano de saúde da Argentina, e compará-los com dados já publicados de outras regiões do mundo. Métodos Estudo transversal foi realizado em um centro de referência terciário em Buenos Aires. Foram recrutados indivíduos saudáveis para se submeterem ao monitoramento esofágico pH-MII 24 horas. As variáveis pH-MII foram registradas e descritas. Resultados A média de eventos de refluxo foi de 20,5 (25-75%, 95%) entre os episódios interquartis: (14-46, 50) e os episódios de refluxo proximal foram de 2,5 (0-10, 11). Sessenta por cento foram episódios de refluxo ácido: 12 (5-29, 38), representando um valor relativamente baixo quando comparado com os relatados em populações europeias, americanas e chinesas. Conclusão Nosso estudo mostra a primeira referência de valores normais de refluxo gastroesofágico em uma população argentina. Encontramos um número total de eventos de refluxo e um número total de eventos de refluxo proximal menor do que o relatado até esta data por outros autores.

Sucroferric oxyhydroxide for hyperphosphatemia: a review of real-world evidence.

Hyperphosphatemia is a common complication in dialysis-dependent patients with chronic kidney disease. Most dialysis-dependent patients need oral phosphate binder therapy to control serum phosphorus concentrations. Most phosphate binders have a high daily pill burden, which may reduce treatment adherence and impair phosphorus control. Sucroferric oxyhydroxide is a potent iron-based phosphate binder approved for use in dialysis-dependent patients in 2013. A randomized controlled trial of sucroferric oxyhydroxide demonstrated its efficacy for reduction of serum phosphorus with a lower pill burden than sevelamer carbonate. Clinical trials carefully select patients, monitor adherence, and routinely titrate medications to a protocol-defined goal. Consequently, trials may not reflect real-world use of medications. Since its approval, we and others have performed retrospective and prospective analyses of sucroferric oxyhydroxide in real-world clinical practice in > 6400 hemodialysis and approximately 500 peritoneal dialysis patients in the USA and Europe. Consistent with the clinical trial data, real-world observational studies have demonstrated that sucroferric oxyhydroxide can effectively reduce serum phosphorus with a lower daily pill burden than most other phosphate binders. These studies have also shown sucroferric oxyhydroxide provides effective serum phosphorus control in different treatment settings, including as monotherapy in phosphate binder-naïve patients, in patients switching from other phosphate binders, or when used in combination with other phosphate binders. These observational studies indicate a favorable safety and tolerability profile, and minimal, if any, systemic iron absorption. This article reviews the key results from these observational studies of sucroferric oxyhydroxide and evaluates its role in the management of hyperphosphatemia in clinical practice.

Linguistic analysis of Latinx patients' responses to a text messaging adjunct during cognitive behavioral therapy for depression.

Cognitive behavioral therapy (CBT) is efficacious to treat depression, however more research is needed to understand its functions among Latinxs. This study analyzed qualitative responses that were paired with a mood rating (1-9 scale) from daily ecological momentary assessments via text-messaging of 52 low-income, Spanish-speaking patients to assess the relationship between word use and changes in mood during group CBT. Based on previous research, we chose 11 linguistic dimensions from the Linguistic Inquiry and Word Count text analysis software that conceptually related to core CBT treatment elements and sociocultural factors of depression in Latinxs. Results showed that the use of words from the categories of Friends, Religion, Positive Emotions, and Leisure (proxy for behavioral activation) were significantly associated with a significant increase in mood. The use of Negative Emotions and Health words were significantly associated with a significant decrease in mood. Post-hoc analysis revealed that Certainty (proxy for cognitive inflexibility) words were related to a significant decrease in mood when Negative Emotional words were present. Findings contribute to our understanding of the role of sociocultural factors and core CBT elements in changes in mood among Latinxs. Lastly, this paper demonstrates the potential for analyzing language content during a digital health intervention to better understand user experiences.

High-Resolution Manometry Thresholds and Motor Patterns Among Asymptomatic Individuals.

OBJECTIVE: High-resolution manometry (HRM) is the current standard for characterization of esophageal body and esophagogastric junction (EGJ) function. We aimed to examine the prevalence of abnormal esophageal motor patterns in health, and to determine optimal thresholds for software metrics across HRM systems. DESIGN: Manometry studies from asymptomatic adults were solicited from motility centers worldwide, and were manually analyzed using integrated relaxation pressure (IRP), distal latency (DL), and distal contractile integral (DCI) in standardized fashion. Normative thresholds were assessed using fifth and/or 95th percentile values. Chicago Classification v3.0 criteria were applied to determine motor patterns across HRM systems, study positions (upright vs supine), ages, and genders. RESULTS: Of 469 unique HRM studies (median age 28.0, range 18-79 years). 74.6% had a normal HRM pattern; none had achalasia. Ineffective esophageal motility (IEM) was the most frequent motor pattern identified (15.1% overall), followed by EGJ outflow obstruction (5.3%). Proportions with IEM were lower using stringent criteria (10.0%), especially in supine studies (7.1%-8.5%). Other motor patterns were rare (0.2%-4.1% overall) and did not vary by age or gender. DL thresholds were close to current norms across HRM systems, while IRP thresholds varied by HRM system and study position. Both fifth and 95th percentile DCI values were lower than current thresholds, both in upright and supine positions. CONCLUSIONS: Motor abnormalities are infrequent in healthy individuals and consist mainly of IEM, proportions of which are lower when using stringent criteria in the supine position. Thresholds for HRM metrics vary by HRM system and study position.

Estomatología 2020, un congreso en tiempos de la pandemia de COVID-19 / Dentistry 2020, a congress in the time of COVID-19

Introducción: La pandemia de COVID-19 introdujo un cambio en la realización del Congreso Internacional en conmemoración el 120 aniversario de la fundación de la Facultad de Estomatología de La Habana, efectuándose de manera virtual en noviembre del 2020. Objetivo: Caracterizar el Congreso Internacional de carácter virtual Estomatología 2020, realizado en tiempos de COVID-19. Métodos: Se realizó una investigación descriptiva, con la aplicación del método histórico-lógico y el de revisión documental, utilizándose los reportes estadísticos finales que brindó el sitio del cónclave. Resultados: En la página del congreso se inscribieron 970 usuarios, de ellos, 899 cubanos y 71 de otros países; todas las provincias estuvieron representadas. El 81 por ciento de los usuarios fueron profesionales y el 16,8 por ciento, estudiantes. Fueron aprobados y publicados 391 trabajos, para un 82,8 por ciento, 373 trabajos eran de autores cubanos y 18 de autores extranjeros. El 18 por ciento de los trabajos correspondieron a estomatología general integral en la atención primaria de salud, seguida de ortodoncia (14,3 por ciento). Se realizaron 2405 comentarios en total, el 92,3 por ciento de los trabajos publicados recibieron comentarios, figuran en las Actas del Congreso 354 trabajos. Conclusiones: La mayoría de los usuarios inscritos fueron cubanos, del sexo femenino y profesionales. Todas las provincias tuvieron representación. La mayoría de los trabajos recibidos reunieron los requisitos para ser publicados y, prácticamente, la quinta parte correspondió a la estomatología general integral en la atención primaria de salud. Fue destacada para participación de estudiantes(AU)

Introduction : Due to the COVID-19 pandemic, the International Congress programmed to mark the 120th anniversary of the Dental School of Havana had to change its format and was held virtually in November 2020. Objective: Characterize the virtual International Congress Dentistry 2020, held in the time of COVID-19. Methods: A descriptive study was conducted based on the final statistical reports provided by the Congress website and applying historical-logical and document review methods. Results: A total 970 users were registered in the Congress page. Of these, 899 were Cuban and 71 were foreign. All the provinces were represented. 81 percent of the users were professionals and 16.8 percent were students. 391 papers were accepted and published, for 82.8 percent; 373 papers were written by Cuban authors and 18 by foreign authors. 18 percent of the papers dealt with general comprehensive dentistry in primary health care, followed by orthodontics (14.3 percent). 2 405 comments were made, with 92.3 percent of the published papers receiving comments. 354 papers were recorded in the Congress Proceedings. Conclusions: Most of the users registered were Cuban, female and professionals. All the provinces were represented. Most of the papers received met the publication requirements and almost one fifth dealt with general comprehensive dentistry in primary health care. Students had an outstanding participation(AU)

A Text Messaging Intervention (StayWell at Home) to Counteract Depression and Anxiety During COVID-19 Social Distancing: Pre-Post Study.

BACKGROUND: Social distancing and stay-at-home orders are critical interventions to slow down person-to-person transmission of COVID-19. While these societal changes help contain the pandemic, they also have unintended negative consequences, including anxiety and depression. We developed StayWell, a daily skills-based SMS text messaging program, to mitigate COVID-19-related depression and anxiety symptoms among people who speak English and Spanish in the United States. OBJECTIVE: This paper describes the changes in StayWell participants' anxiety and depression levels after 60 days of exposure to skills-based SMS text messages. METHODS: We used self-administered, empirically supported web-based questionnaires to assess the demographic and clinical characteristics of StayWell participants. Anxiety and depression were measured using the 2-item Generalized Anxiety Disorder (GAD-2) scale and the 8-item Patient Health Questionnaire-8 (PHQ-8) scale at baseline and 60-day timepoints. We used 2-tailed paired t tests to detect changes in PHQ-8 and GAD-2 scores from baseline to follow-up measured 60 days later. RESULTS: The analytic sample includes 193 participants who completed both the baseline and 60-day exit questionnaires. At the 60-day time point, there were significant reductions in both PHQ-8 and GAD-2 scores from baseline. We found an average reduction of -1.72 (95% CI -2.35 to -1.09) in PHQ-8 scores and -0.48 (95% CI -0.71 to -0.25) in GAD-2 scores. These improvements translated to an 18.5% and 17.2% reduction in mean PHQ-8 and GAD-2 scores, respectively. CONCLUSIONS: StayWell is an accessible, low-intensity population-level mental health intervention. Participation in StayWell focused on COVID-19 mental health coping skills and was related to improved depression and anxiety symptoms. In addition to improvements in outcomes, we found high levels of engagement during the 60-day intervention period. Text messaging interventions could serve as an important public health tool for disseminating strategies to manage mental health. TRIAL REGISTRATION: ClinicalTrials.gov NCT04473599; https://clinicaltrials.gov/ct2/show/NCT04473599. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/23592.

Mortality in Hemodialysis Patients with COVID-19, the Effect of Paricalcitol or Calcimimetics.

BACKGROUND: In COVID-19 patients, low serum vitamin D (VD) levels have been associated with severe acute respiratory failure and poor prognosis. In regular hemodialysis (HD) patients, there is VD deficiency and markedly reduced calcitriol levels, which may predispose them to worse outcomes of COVID-19 infection. Some hemodialysis patients receive treatment with drugs for secondary hyperparathyroidism, which have well known pleiotropic effects beyond mineral metabolism. The aim of this study was to evaluate the impact of VD status and the administration of active vitamin D medications, used to treat secondary hyperparathyroidism, on survival in a cohort of COVID-19 positive HD patients. METHODS: A cross-sectional retrospective observational study was conducted from 12 March to 21 May 2020 in 288 HD patients with positive PCR for SARS-CoV2. Patients were from 52 different centers in Spain. RESULTS: The percent of HD patients with COVID-19 was 6.1% (288 out of 4743). Mortality rate was 28.4% (81/285). Three patients were lost to follow-up. Serum 25(OH)D (calcidiol) level was 17.1 [10.6-27.5] ng/mL and was not significantly associated to mortality (OR 0.99 (0.97-1.01), p = 0.4). Patients receiving active vitamin D medications (16/94 (17%) vs. 65/191(34%), p = 0.003), including calcimimetics (4/49 (8.2%) vs. 77/236 (32.6%), p = 0.001), paricalcitol or calcimimetics (19/117 (16.2%) vs. 62/168 (36.9%); p < 0.001), and also those on both paricalcitol and calcimimetics, to treat secondary hyperparathyroidism (SHPTH) (1/26 (3.8%) vs. 80/259 (30.9%), p < 0.001) showed a lower mortality rate than patients receiving no treatment with either drug. Multivariate Cox regression analysis confirmed this increased survival. CONCLUSIONS: Our findings suggest that the use of paricalcitol, calcimimetics or the combination of both, seem to be associated with the improvement of survival in HD patients with COVID-19. No correlation was found between serum VD levels and prognosis or outcomes in HD patients with COVID-19. Prospective studies and clinical trials are needed to support these findings.