A systematic review of patient access to medical records in the acute setting: practicalities, perspectives and ethical consequences.

BACKGROUND: Internationally, patient access to notes is increasing. This has been driven by respect for patient autonomy, often recognised as a primary tenet of medical ethics: patients should be able to access their records to be fully engaged with their care. While research has been conducted on the impact of patient access to outpatient and primary care records and to patient portals, there is no such review looking at access to hospital medical records in real time, nor an ethical analysis of the issues involved in such a change in process. METHODS: This study employed a systematic review framework in two stems, to integrate literature identified from two searches: Medline, CINAHL and Scopus databases were conducted, (for (1) hospitalised patients, patient access to records and its effects on communication and trust within the doctor-patient relationship; and (2) patient access to medical records and the ethical implications identified). The qualitative and quantitative results of both searches were integrated and critically analysed. RESULTS: 3954 empirical and 4929 ethical studies were identified; 18 papers representing 16 studies were identified for review (12 empirical and 6 ethical). The review reveals a consensus that our current approach to giving information to patients - almost exclusively verbally - is insufficient; that patient access to notes is a welcome next step for patient-centred care, but that simply allowing full access, without explanation or summary, is also insufficient. Several ethical implications need to be considered: increased information could improve patient trust and knowledge but might transfer an (unwelcome) sense of responsibility to patients; doctors and patients have conflicting views on how much information should be shared and when; sharing written information might increase the already significant disparity in access to health care, and have unforeseen opportunity costs. The impact on medical practice of sharing notes in real time will also need to be evaluated. CONCLUSIONS: The review presents encouraging data to support patient access to medical notes. However, sharing information is a critical part of clinical practice; changing how it is done could have significant empirical and ethical impacts; any changes should be carefully evaluated.

Latina/o Children Living With an Immigrant Mother With Depression: Developmental and Cultural Nuances in Recognition and Coping.

The psychological experience of maternal depression and its impact on immigrant Latina/o families often goes unrecognized and unaddressed. Children may feel especially helpless and confused about the changes they observe in their mothers' mood and behavior, and about the deterioration of family relationships. Given the interdependence of family structures of immigrant Latina/o households, maternal depression can be detrimental to Latina/o youth attributions and coping strategies, and to their relationship with their mothers. The quantitative focus of most research on maternal depression in Latina/o samples limits our understanding of family processes in maternal depression. The current qualitative study explores the perceived impact of maternal depression on Latina/o youths' attributions and coping strategies. This inquiry involved focus groups with 12 participants aged 9-16 years to explore their perspectives on maternal depression. All youth had participated in a 12-week multifamily group intervention focused on building family and cultural strengths to address maternal depression on immigrant Latina/o families. Findings of the focus groups illuminated the essential experience of youth living with maternal depression, and indicated that there are developmental considerations for how youth recognize and make meaning of maternal depression, and cope with disrupted family life. Additionally, youth reported engaging in these culture-specific ways of coping: using close sibling relationships and family structure as support, having fathers and extended family members engage in additional and restorative parenting practices, and participating in religious practices to seek refuge from family stress. We propose considerations for intervention and further areas of research.

La experiencia psicológica de la depresión materna y su efecto en las familias de inmigrantes latinos generalmente no se reconoce ni se trata. Los niños pueden sentirse especialmente desamparados y confundidos con respecto a los cambios que observan en el estado de ánimo y la conducta de sus madres, y con respecto al deterioro de las relaciones familiares. Dada la interdependencia de las estructuras familiares de los hogares de los inmigrantes latinos, la depresión materna puede ser perjudicial para las estrategias de adaptación y las atribuciones de los jóvenes latinos así como para sus relaciones con sus madres. El enfoque cuantitativo de la mayoría de las investigaciones sobre depresión materna en muestras de latinos limita nuestra comprensión de los procesos familiares en la depresión materna. El presente estudio cualitativo analiza el efecto percibido de la depresión materna en las estrategias de adaptación y las atribuciones de los jóvenes latinos. Esta investigación consistió en grupos focales con 12 participantes de entre 9 y 16 años para analizar sus perspectivas sobre la depresión materna. Todos los jóvenes habían participado en una intervención grupal multifamiliar de 12 semanas centrada en el refuerzo de los puntos fuertes familiares y culturales para abordar la depresión materna en las familias de inmigrantes latinos. Los resultados de los grupos focales aclararon la experiencia fundamental de los jóvenes que viven con depresión materna e indicaron que existen consideraciones del desarrollo en cuanto a cómo los jóvenes reconocen y entienden la depresión materna, y hacen frente a una vida familiar perturbada. Además, los jóvenes informaron que recurrieron a estas formas de afrontamiento propias de su cultura: usaron como apoyo las relaciones estrechas entre hermanos y la estructura familiar, pidieron a los padres y a parientes lejanos que participen en prácticas de crianza adicionales y fortalecedoras, y participaron en prácticas religiosas para refugiarse del estrés familiar. Proponemos consideraciones sobre intervenciones y otras áreas de investigación.

A Community-Responsive Adaptation to Reach and Engage Latino Families Affected by Maternal Depression.

As family researchers and practitioners seek to improve the quality and accessibility of mental health services for immigrant families, they have turned to culturally adapted interventions. Although many advancements have been made in adapting interventions for such families, we have yet to understand how the adaptation can ensure that the intervention is reaching families identified to be in greatest need within a local system of care and community. We argue that reaching, engaging, and understanding the needs of families entails a collaborative approach with multiple community partners to ensure that adaptations to intervention content and delivery are responsive to the sociocultural trajectory of families within a community. We describe a cultural adaptation framework that is responsive to the unique opportunities and challenges of identifying and recruiting vulnerable families through community partnerships, and of addressing the needs of families by incorporating multiple community perspectives. Specifically, we apply these principles to the cultural adaptation of an intervention originally developed for low-income African American and White families facing maternal depression. The new intervention, Fortalezas Familiares (Family Strengths), was targeted to Latino immigrant families whose mothers were in treatment for depression in mental health and primary care clinics. We conclude with key recommendations and directions for how family researchers and practitioners can design the cultural adaptation of interventions to be responsive to the practices, preferences, and needs of underserved communities, including families and service providers.

Collaborative mental health for children: Perspectives of school and clinical psychologists.

There is a need for increased collaboration between mental health providers who work with children and youth to increase continuity of care across settings. While schools can be an optimal location for mental health support, school psychologists often have to work with clinical providers given the increases in youth mental health needs and the shortage of school-based providers. This study used an online survey with a mixed-methods approach to understand the collaboration practices of school and clinical psychologists. A sample of 57 practitioners in the United States were asked to provide their perceptions of the roles of their interagency providers, their collaboration practices, and the benefits or barriers in the collaboration process. Findings indicated differences in providers' perceptions of the quality of assessments conducted and the importance of particular psychological practices to the roles of clinical and school psychologists. Content analysis of open-ended responses found that while providers acknowledge the benefits of collaboration there was distrust among providers. Implications for training programs and future research directions are discussed. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Cardiorespiratory and Emotional Responses During Balance Exercises.

Purpose: Physical exercises on unstable surfaces have been largely applied for clinical practice as well as in sports training. Although the unsteadiness can lead to physiological and psychological adaptations, little is known about the autonomic and emotional acute responses during the practice of balance exercises. This study aimed to evaluate both cardiorespiratory and emotional responses while standing on different unstable surfaces. Methods: Eighty-eight healthy participants performed postural balance tasks in three experimental conditions: (1) a rigid surface (control); (2) balance pad; and (3) the Both Sides Up (BOSU) ball. Respiratory activity was recorded through the thoracic movement and the heart rate variability by the electrocardiographic signal during the balance tasks. After the participants evaluated the level of perceived stability and emotional aspects related to each experimental condition. Results: The main results showed that BOSU condition was perceived as more unstable, unpleasant, with higher arousal and lower dominance levels (p < .05). Accordingly, participants had also an increase in the mean respiratory frequency and heart rate (p < .05). Conclusion: These results showed that the postural task with greater instability prompted congruent physiological adjustments to ensure the homeostasis in the more challenging condition. Therefore, the cardiorespiratory and emotional responses should be considered to ensure the safety and benefits in rehabilitation programs in which the exercise progression is based on unstable surfaces.

The diversity present in 5140 human mitochondrial genomes.

We analyzed the current status (as of the end of August 2008) of human mitochondrial genomes deposited in GenBank, amounting to 5140 complete or coding-region sequences, in order to present an overall picture of the diversity present in the mitochondrial DNA of the global human population. To perform this task, we developed mtDNA-GeneSyn, a computer tool that identifies and exhaustedly classifies the diversity present in large genetic data sets. The diversity observed in the 5140 human mitochondrial genomes was compared with all possible transitions and transversions from the standard human mitochondrial reference genome. This comparison showed that tRNA and rRNA secondary structures have a large effect in limiting the diversity of the human mitochondrial sequences, whereas for the protein-coding genes there is a bias toward less variation at the second codon positions. The analysis of the observed amino acid variations showed a tolerance of variations that convert between the amino acids V, I, A, M, and T. This defines a group of amino acids with similar chemical properties that can interconvert by a single transition.

Managing acute cardiac valvular emergencies in the emergency department.

Valvular heart disease is becoming more prevalent as the United States' population ages, with aortic and mitral valves most commonly affected. Complications, including syncope, heart failure, dyspnea, and chest pain, can arise from slow progression of stenosis and regurgitation, though acute regurgitation from an ischemic or traumatic event can be life-threatening. Patients with valvular disease may present with cardiogenic shock, and vasoactive agent treatment will depend on determination of the valvular etiology. This issue reviews aortic and mitral valvular disease as potential causes of a patient's emergency department presentation, including history, diagnostic testing, and physical examination findings that can help guide treatment.

Outcomes of COVID-19 on Latinx youth: Considering the role of adverse childhood events and resilience.

Early research on the COVID-19 pandemic has demonstrated differential impact on the Latinx community. There has been limited research exploring the mental health outcomes of the pandemic on Latinx youth. This study explores the severity of pandemic-related stress on Latinx youth considering their resilience factors and previous adverse childhood events (ACEs). Adolescents (n = 142) ages 13-18 completed measures related to exposure to the pandemic, pandemic stress, number of ACEs, resilience factors, and general demographic information. Results of multiple regression analysis found that exposure to the pandemic, ACEs, gender, and resilience factors predicted the levels of stress that youth experienced. No differences in pandemic-related stress were found between Latinx youth and their non-Latinx counterparts. Implications are discussed related to how school psychologists can support all students with culturally sensitive practices as we continue through the pandemic and beyond. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Crisis and Adolescents: Assessments and Initial Management.

Adolescents often experience trauma that can affect their daily function and lead to health-related issues and outcomes. However, medical providers receive limited training on the impact of trauma on adolescents and how to incorporate that information into treatment practices. This article highlights the impact of crisis and trauma on adolescents. An overview of current assessments and evidence-based interventions to address adolescent patients' crisis needs is provided. In addition, recommendations for community referrals and partnerships that could improve the health outcomes of these youth are discussed.

Vector competence and feeding-excretion behavior of Triatoma rubrovaria (Blanchard, 1843) (Hemiptera: Reduviidae) infected with Trypanosoma cruzi TcVI.

BACKGROUND: Several studies addressed changes on the insect vector behavior due to parasite infection, but little is known for triatomine bugs, vectors of Trypanosoma cruzi, the etiological agent of Chagas disease. We assessed infection rates and metacyclogenesis of T. cruzi (TcVI) in fifth-instar nymphs of Triatoma rubrovaria comparing with the primary vector Triatoma infestans. Also, biological parameters related to feeding-excretion behavior were evaluated aiming to identify which variables are most influenced by T. cruzi infection. METHODOLOGY/PRINCIPAL FINDINGS: Fifth-instar nymphs of T. rubrovaria and T. infestans were fed on mice infected with T. cruzi (TcVI). We compared the presence and the number of parasite evolutive forms in excreta of both triatomine species at 30, 60 and 90 days post-infection (dpi) with traditional statistical analyses. Moreover, both species were analyzed through generalized linear models and multinomial logistic regression hypotheses for seven behavioral parameters related to host-seeking and feeding-excretion. Triatoma rubrovaria and T. infestans had similar overall infection and metacyclogenesis rates of T. cruzi TcVI in laboratory conditions. Regarding vector behavior, we confirmed that the triatomine's tendency is to move away from the bite region after a blood meal, probably to avoid being noticed by the vertebrate host. Interspecific differences were observed on the volume of blood ingested and on the proportion of individuals that excreted after the blood meal, revealing the higher feeding efficiency and dejection rates of T. infestans. The amount of ingested blood and the bite behavior of T. rubrovaria seems to be influenced by TcVI infection. Infected specimens tended to ingest ~25% more blood and to bite more the head of the host. Noteworthy, in two occasions, kleptohematophagy and coprophagy behaviors were also observed in T. rubrovaria. CONCLUSIONS/SIGNIFICANCE: Laboratory infections revealed similar rate of T. cruzi TcVI trypomatigotes in excreta of T. rubrovaria and T. infestans, one of the most epidemiological important vectors of T. cruzi. Therefore, TcVI DTU was able to complete its life cycle in T. rubrovaria under laboratory conditions, and this infection changed the feeding behavior of T. rubrovaria. Considering these results, T. rubrovaria must be kept under constant entomological surveillance in Rio Grande do Sul, Brazil.

Clinical Pharmacists Improve Patient Outcomes and Expand Access to Care.

The United States Public Health Service National Clinical Pharmacy Specialist Committee issues a report on the impact of pharmacy-managed clinics across the Bureau of Prisons, Immigration and Customs Enforcement, Indian Health Service, and US Coast Guard.

Epidemiological Profile of Patients with Crohn's Disease and Ulcerative Colitis in the Last 6 Years / Perfil Epidemiológico de Pacientes com Doença de Crohn e Colite Ulcerativa nos Últimos 6 Anos

Abstract Inflammatory bowel diseases, Crohn's Disease and Ulcerative Colitis, are two relevant changes in the intestinal microbiota of individuals who are subject to environmental and genetic changes. With the social development and, mainly, the spread of industrialization, the increase in gastrointestinal diseases was observed on a large scale. Therefore, the study permeated to relate and obtain its results according to ethnicity, sex, phenotypic alterations of PID and gender, which are risk factors for these diseases. To characterize the epidemiological profile of patients with Crohn's Disease and Ulcerative Colitis in Brazil in the last 6 years. This is a time series epidemiological study with the objective of collecting data from patients who were diagnosed with Crohn's Disease and Ulcerative Colitis, in all Brazilian regions from 2014 to 2019. Data will be collected in the System of SUS Hospital Information (SIH/SUS), within a period of 6 years and for the analysis of these data, sociodemographic variables will be used, namely: ethnicity, sex, region, age group and admissions number, being accessed on 09/22/2020. The panorama presented shows high rates of hospitalization in the Southeast and Northeast regions, the diagnosis for the two diseases predominate in the South region, females, ethnicity/white race and age group between 20 and 29 years highlighted. Thus, the intervention of public policies that improve the population's health condition is of paramount importance. (AU)

Resumo As doenças inflamatórias intestinais, Doença de Crohn e a Colite Ulcerativa, são duas alterações pertinentes na microbiota intestinal de indivíduos que estão sujeitos a mudanças do ambiente e genéticas. Com o desenvolvimento social e, principalmente, alastramento da industrialização o aumento das doenças gastrintestinais foi observado em larga escala. Sendo assim, o estudo permeou em relacionar e obter os seus resultados de acordo a etnia, sexo, alterações fenotípicas de IDP e gênero, que são fatores de riscos para essas doenças. O objetivo desse estudo foi caracterizar o perfil epidemiológico de pacientes com doença de Crohn e colite ulcerativa, no Brasil, nos últimos 6 anos. Trata-se de um estudo epidemiológico de serie temporal com o objetivo de coletar dados de pacientes que foram diagnosticados com doença de Crohn e colite ulcerativas, em todas as regiões brasileiras no período de 2014 até 2019. Os dados serão coletados no Sistema de Informações Hospitalares do SUS (SIH/SUS), dentro do período de 6 anos e para a análise desses dados, serão utilizadas as variáveis sociodemográficas, que são: etnia, sexo, região, faixa etária e números de internações, sendo acessado no dia 22/09/2020. O panorama apresentado demostra altas taxas de internação nas regiões sudeste e nordeste, o diagnóstico para as duas doenças predominam na região sul, o sexo feminino, etnia/raça branca e faixa etária entre 20 e 29 anos em destaque. Desta forma, é de suma importância a intervenção de políticas públicas que melhorem a condição de saúde da população. (AU)

Prevalence of Child Sexual Violence in Brazil in the Period 2010-2018: an Ecological Study / Prevalência de Violência Sexual Infantil no Brasil no Período de 2010-2018: um Estudo Ecológico

Abstract Violence is characterized as a sociocultural phenomenon that can affect the individual physically, psychosocially and cognitively. Child sexual abuse is one of the biggest public health problems, however, its prevalence is still undefined. It is also the cause of several psychopathological disorders and future difficulties in the context of the victim's interpersonal and sexual relationships. To describe the prevalence of child sexual abuse in Brazil in the of period 2010 ­ 2018. Descriptive ecological study, whose data were obtained by consulting the SINAN database, made available by DATASUS. Where cases of child sexual violence between 0 and 14 years old were selected from 2010 to 2018. A steady progression was evidenced in all regions and in almost every year, in cases of sexual violence. The North and South regions have the highest prevalence. Cases were more frequent in females (82.7%), between 10 and 14 years old (49%), with the main aggressors being parents (13.8%) and stepfathers (12.9%). The prevalence of child sexual violence is higher among children aged 10 to 14 years, female and the cases are more concentrated in the north region. (AU)

Resumo A violência é caracterizada como um fenômeno sociocultural que pode afetar o indivíduo em âmbito físico, psicossocial e cognitivo. O abuso sexual infantil é um dos maiores problemas de saúde pública, porém, sua prevalência ainda é indefinida. Sendo também causador de diversos transtornos psicopatológicos e dificuldades futuras em âmbito de relações interpessoais e sexuais da vítima. Portanto o objetivo do presente estudo é descrever a prevalência do abuso sexual infantil no Brasil no período de 2010 - 2018. Trata-se de um estudo ecológico descritivo, cujos dados foram obtidos por meio de consulta à base de dados SINAN, disponibilizados pelo DATASUS. Onde foram selecionados os casos de violência sexual infantil, de 0 a 14 anos registrada no período de 2010 a 2018. Foi evidenciado uma progressão contínua em todas as regiões e em quase todos os anos, nos casos de violência sexual. As Regiões Norte e Sul apresentam maior prevalência. Os casos eram mais frequentes no sexo feminino (82,7%), entre 10 e 14 anos (49%), sendo os principais agressores pais (13,8%) e padrastos (12,9%). Pode-se concluir que a prevalência de violência sexual infantil é maior entre crianças de 10 a 14 anos, do sexo feminino e os casos estão mais concentrados na região Norte. (AU)

Varsity Medical Ethics Debate 2015: should nootropic drugs be available under prescription on the NHS?

The 2015 Varsity Medical Ethics debate convened upon the motion: "This house believes nootropic drugs should be available under prescription". This annual debate between students from the Universities of Oxford and Cambridge, now in its seventh year, provided the starting point for arguments on the subject. The present article brings together and extends many of the arguments put forward during the debate. We explore the current usage of nootropic drugs, their safety and whether it would be beneficial to individuals and society as a whole for them to be available under prescription. The Varsity Medical Debate was first held in 2008 with the aim of allowing students to engage in discussion about ethics and policy within healthcare. The event is held annually and it is hoped that this will allow future leaders to voice a perspective on the arguments behind topics that will feature heavily in future healthcare and science policy. This year the Oxford University Medical Society at the Oxford Union hosted the debate.

Determination of Abraham model solute descriptors for the monomeric and dimeric forms of trans-cinnamic acid using measured solubilities from the Open Notebook Science Challenge.

BACKGROUND: Calculating Abraham descriptors from solubility values requires that the solute have the same form when dissolved in all solvents. However, carboxylic acids can form dimers when dissolved in non-polar solvents. For such compounds Abraham descriptors can be calculated for both the monomeric and dimeric forms by treating the polar and non-polar systems separately. We illustrate the method of how this can be done by calculating the Abraham descriptors for both the monomeric and dimeric forms of trans-cinnamic acid, the first time that descriptors for a carboxylic acid dimer have been obtained. RESULTS: Abraham descriptors were calculated for the monomeric form of trans-cinnamic acid using experimental solubility measurements in polar solvents from the Open Notebook Science Challenge together with a number of water-solvent partition coefficients from the literature. Similarly, experimental solubility measurements in non-polar solvents were used to determine Abraham descriptors for the trans-cinnamic acid dimer. CONCLUSION: Abraham descriptors were calculated for both the monomeric and dimeric forms of trans-cinnamic acid. This allows for the prediction of further solubilities of trans-cinnamic acid in both polar and non-polar solvents with an error of about 0.10 log units. Graphical abstractMolar concentration of trans-cinnamic acid in various polar and non-polar solvents.

Cervicovaginal fetal fibronectin levels in women with preeclampsia.

OBJECTIVE: To estimate the mean levels of fetal fibronectin in cervicovaginal secretions of women with preeclampsia and compare them with levels in normotensive controls. METHODS: Cervicovaginal swabs were obtained before digital examination from women who presented to labor and delivery for evaluation of preeclampsia and compared with fetal fibronectin levels from a group of control subjects with a similar gestational age. Fetal fibronectin was assayed by a specific enzyme-linked immunoassay. A concentration greater than 50 ng/mL was considered a positive result. RESULTS: Forty women with preeclampsia (17 mild and 23 severe) and 31 normotensive women were analyzed. The control group had 9.7% positive fetal fibronectins, whereas the preeclampsia group had 15% positive, P =.72, with 80% power to detect a 22% difference. The majority of the quantitative values in both groups were less than 20 ng/mL. There was not a significant difference between the two groups in quantitative cervicovaginal fetal fibronectin, P =.72, nor was there a difference between the women with severe preeclampsia and the controls, P = 1.0, or between the nulliparous women with preeclampsia versus the nulliparous controls, P =.3. CONCLUSION: Fetal fibronectin is not elevated in cervicovaginal secretions of women with preeclampsia.

'SiCKO ­ SOS Saúde' e a mercantilização da vida / SiCKO and the commodification of life

SiCKO é um documentário de Michael Moore que critica o sistema de saúde dos Estados Unidos da América e apresenta como negociatas políticas e lobbying de seguradoras de saúde e empresas farmacêuticas mantêm um sistema que trata saúde como mercadoria, martirizando vidas em nome do lucro. O exemplo de outros países que adotaram a medicina socializada serve para mostrar uma proposta alternativa de saúde, entendida como um direito de todos, financiado solidariamente pela sociedade e garantido através de políticas públicas e práticas eficazes.