Code stroke in Asturias.

BACKGROUND: Intravenous thrombolysis with alteplase is an effective treatment for ischaemic stroke when applied during the first 4.5 hours, but less than 15% of patients have access to this technique. Mechanical thrombectomy is more frequently able to recanalise proximal occlusions in large vessels, but the infrastructure it requires makes it even less available. METHODS: We describe the implementation of code stroke in Asturias, as well as the process of adapting various existing resources for urgent stroke care in the region. By considering these resources, and the demographic and geographic circumstances of our region, we examine ways of reorganising the code stroke protocol that would optimise treatment times and provide the most appropriate treatment for each patient. RESULTS: We distributed the 8 health districts in Asturias so as to permit referral of candidates for reperfusion therapies to either of the 2 hospitals with 24-hour stroke units and on-call neurologists and providing IV fibrinolysis. Hospitals were assigned according to proximity and stroke severity; the most severe cases were immediately referred to the hospital with on-call interventional neurology care. Patient triage was provided by pre-hospital emergency services according to the NIHSS score. CONCLUSIONS: Modifications to code stroke in Asturias have allowed us to apply reperfusion therapies with good results, while emphasising equitable care and managing the severity-time ratio to offer the best and safest treatment for each patient as soon as possible.

Study protocol for a randomized controlled trial of supportive parents - coping kids (SPARCK)-a transdiagnostic and personalized parent training intervention to prevent childhood mental health problems.

BACKGROUND: To meet the scientific and political call for effective prevention of child and youth mental health problems and associated long-term consequences, we have co-created, tested, and optimized a transdiagnostic preventive parent-training intervention, Supportive parents - coping kids (SPARCK), together with and for the municipal preventive frontline services. The target group of SPARCK is parents of children between 4 and 12 years who display symptoms of anxiety, depression, and/or behavioral problems, that is, indicated prevention. The intervention consists of components from various empirically supported interventions representing different theorical models on parent-child interactions and child behavior and psychopathology (i.e., behavioral management interventions, attachment theory, emotion socialization theory, cognitive-behavioral therapy, and family accommodation intervention). The content and target strategies of SPARCK are tailored to the needs of the families and children, and the manual suggests how the target strategies may be personalized and combined throughout the maximum 12 sessions of the intervention. The aim of this project is to investigate the effectiveness of SPARCK on child symptoms, parenting practices, and parent and child stress hormone levels, in addition to later use of specialized services compared with usual care (UC; eg. active comparison group). METHODS: We describe a randomized controlled effectiveness trial in the frontline services of child welfare, health, school health and school psychological counselling services in 24 Norwegian municipalities. It is a two-armed parallel group randomized controlled effectiveness and superiority trial with 252 families randomly allocated to SPARCK or UC. Assessment of key variables will be conducted at pre-, post-, and six-month follow-up. DISCUSSION: The current study will contribute with knowledge on potential effects of a preventive transdiagnostic parent-training intervention when compared with UC. Our primary objective is to innovate frontline services with a usable, flexible, and effective intervention for prevention of childhood mental health problems to promote equity in access to care for families and children across a heterogeneous service landscape characterized by variations in available resources, personnel, and end user symptomatology. TRIAL REGISTRATION: ClinicalTrials.gov ID: NTCT05800522.

Mental health versus substance abuse treatment programs for dually diagnosed patients.

The aim of this study was to assess the similarities and differences of patients with co-existing psychiatric and substance use disorders attending treatment in either a mental health setting or a substance abuse treatment setting. A total of 129 patients were assessed, including 65 individuals from the substance abuse treatment center and 64 individuals from the mental health program. Treatment records were reviewed for diagnoses and sociodemographic data. While the two groups were highly similar with regard to age and ethnicity, there were significant differences in psychiatric profile, with the substance abuse treatment group having less severe diagnoses and no patients with schizophrenia, while the mental health treatment group had a majority of patients with schizophrenia. Other differences in the two groups, such as marital and parental status, disability status, and medical problems appeared to be directly linked with the aforementioned diagnostic profile. These data suggest important differences in characteristics of patients with comorbid disorders that appear to be dependent on the type of treatment program they attend. For the most effective management, integrated treatment programs should be aware of these differences and tailor service provision accordingly.

Qualitative and quantitative research in social epidemiology: is complementarity the only issue?

Although in recent years there has been a growing acceptance of qualitative research in social epidemiology, the role and scope of its use remain a contested terrain. We sketch some of the issues that have been the focus of the debate between supporters and critics of qualitative research in social epidemiology and adjacent public health disciplines. They include epistemological problems, such as the limitations of survey research to uncover social mechanisms, lack of background among epidemiologists to generate sound hypotheses for specific populations, and ontological problems such the idealism inherent in some of the qualitative research coming from anthropology. Next we review the urban ethnographies of Elliot Liebow's and a decade of population based research in African American and low income neighborhoods in the United States to expose another role for qualitative research in social epidemiology. Thus, we argue that qualitative research has been used in scientific debates that confront egalitarian researchers with institutions or peers with opposing economic interests and ideologies. Qualitative research is often a powerful tool to fuel alternative theoretical frameworks and measures to be included in quantitative population based surveys. We confine this use of qualitative research to the academic world and do not necessarily imply that communities benefit from it as in action research.

[Pyoderma gangrenosum with an atypical location and a rapid response to cyclosporin A]. / Pioderma gangrenoso de localización atípica y rápida respuesta a la ciclosporina A.

Pyoderma gangrenosum is an unusual neutrophilic dermatosis associated to different rheumatologic, haematologic and inflammatory bowel diseases which generally responds to the therapy of the underlying disease. We report a case of pyoderma in a 44-years-old woman with paucisymptomatic, distal, ulcerative colitis which appeared simultaneously in her forehead and hands. We think it of general interest because of its localization, its importance, the failure of response to steroids and the need of cyclosporine A for regression.

[Salmonella: comparison of methods for its detection in bird feed]. / Salmonella: comparación de dos métodos para su detección en alimentos para aves.

The Gene Trak colorimetric hybridization method (GENE TRAK Systems, 31 New York Avenue, Framingham, M.A.) was compared with conventional methodology proposed by International Commission for Microbiological Standard Foods (ICMSF) for the detection of Salmonella in samples of broiler feed and raw materials of vegetal and animal origin used in its formulation. In this study 249 samples which included inoculated samples and 9 uninoculated samples were studied. On 240 uninoculated samples, 62.9% resulted free of Salmonella, 27.9% were positive for both methods and 9.2% were positive by Gene Trak but it couldn't be confirmed by conventional methodology after five determinations. This methodology is presented as an interesting method of screening with important advantages in comparison to conventional methodology: facility for processing a big number of samples with few material expenses, less time to get results and high sensibility.

The treatment of mice with Lactobacillus casei induces protection against Babesia microti infection.

In this study, we report that administration of Lactobacillus casei confers protection to mice against the intracellular protozoan Babesia microti. Mice treated with L. casei orally or intraperitoneally were inoculated 7 days later with an infectious dose of B. microti. Mice treated with lactobacilli showed significant reduction in the percentage of parasitized erythrocytes (PPE) compared to untreated mice. When mice were inoculated intraperitoneally with L. casei 3 or 0 days before challenge with B. microti, the PPE was significantly lower compared to untreated mice and there were no differences between treated mice and mice immune to B. microti infection. When mice treated with live or dead L. casei were compared to mice inoculated with Freund Complete Adjuvant before a B. microti infection, a significant reduction of PPE was observed. These results show the protective effect of L. casei administered to mice against a B. microti infection and suggest that it might act by stimulating the innate immune system.

Antibody to adhesion molecule LFA-1 enhances plasma neutralization of human immunodeficiency virus type 1.

We have shown that a monoclonal antibody to the cell surface adhesion molecule LFA-1 (CD18/CD11a) enhances plasma neutralization of a laboratory isolate (HIVMN) and a primary isolate (HIV28R) of human immunodeficiency virus type 1. Human phytohemagglutinin blasts were infected with HIVMN or HIV28R in the presence of plasma pooled from HIV-positive individuals (AIDS plasma) or immunoglobulin G from AIDS plasma alone or combined with a monoclonal antibody (MAb) to LFA-1. While AIDS plasma alone at a dilution of 1:1,250 neutralized HIVMN and HIV28R infection by 15 and 0%, respectively, in the presence of a saturating concentration of the MAb to LFA-1 the plasma neutralized both viruses by more than 80% at this dilution. Immunoglobulin G purified from AIDS plasma, when used in combination with the MAb to LFA-1, showed the same synergistic effect in HIV neutralization as seen with the AIDS plasma and anti-LFA-1. The MAb against LFA-1 partially neutralized both viral isolates (45 to 55%) on its own. These results demonstrate significant synergy between the plasma and antibody against LFA-1 in the neutralization of HIV. The observations therefore suggest an important role for adhesion molecules in HIV infectivity and transmission. The results have implications for the recently observed host effect on HIV susceptibility to antibody neutralization.

Severely mentally ill patients with and without substance use disorders: characteristics associated with treatment attrition.

We aimed to describe characteristics associated with attrition for patients in community mental health treatment with chronic mental illness with and without substance use disorders. Baseline assessments included symptom severity, treatment satisfaction, social support, and a structured diagnostic interview. Treatment attrition was assessed at six months. At six months, 36% of the dual diagnosis group (n = 25), and 61% of the mental illness alone group (n = 23) were lost to follow-up. Attrition in the dually diagnosed group tended to be associated with less satisfaction with treatment, and higher mean symptom scores. There were no characteristics associated with attrition in the group of patients with mental illness alone. However, client satisfaction tended to increase among the mental illness alone patients that were successfully followed. The dually diagnosed group that remained in treatment had a significantly lower mean treatment satisfaction score than the mental illness alone group at six months. This type of investigation should aid in patient care and evaluation of treatment programs for persons with severe mental illness and co-occurring substance use disorders.

A description of precipitants of drug use among dually diagnosed patients with chronic mental illness.

In this report, we describe patients' perceptions of the chronological occurrence of their mental illness and substance abuse. The patients were enrolled in a community mental health center and received dual diagnosis treatment from an affiliated psychiatric rehabilitation program. Using a questionnaire designed to address this issue, we assessed patients' perceptions of support currently being received at the treatment program and how beneficial they perceived this support to be. In addition, we assessed why substance use was a coping strategy in times of perceived stress early in life and whether this behavior has changed to date. Assessing the perception of the sequence of co-occurring disorders among patients enables us to better understand the factors that precipitate substance use and exacerbate mental illness. This knowledge may aid in the design of effective treatment strategies for this population of patients.

Qualitative and quantitative research in social epidemiology: is complementarity the only issue? / Investigación cualitativa y cuantitativa en epidemiología social, ¿es simplemente una cuestión de complementariedad?

A pesar de que en los últimos años hemos asistido a una creciente aceptación de la investigación cualitativa en el campo de la epidemiología social, el papel y el ámbito de su utilización continúa siendo un campo de debate. En este trabajo presentamos algunos de los temas que han sido el centro del debate entre los investigadores a favor y en contra de la metodología cualitativa para la investigación en epidemiología social y disciplinas relacionadas de la salud pública. Entre los puntos de controversia hay problemas epistemológicos, como las limitaciones de la investigación mediante encuestas para abordar mecanismos sociales, la ausencia de un marco conceptual en los epidemiólogos para generar hipótesis relevantes para poblaciones específicas, y problemas ontológicos como el idealismo inherente a la investigación cualitativa proveniente de la antropología. Se revisan a continuación las etnografías urbanas de Elliot Liebow y una década de investigación en población afroamericana y barrios desfavorecidos en los Estados Unidos para exponer otro papel de la investigación cualitativa en epidemiología social. Así, sostenemos que la investigación cualitativa se ha utilizado en debates científicos en los que se confrontan investigadores igualitaristas con instituciones u otros investigadores con intereses económicos e ideologías opuestas. A menudo la investigación cualitativa es una potente herramienta para apoyar medidas y marcos teóricos alternativos que puedan ser incluidos en estudios poblacionales cuantitativos. Creemos que este uso de la investigación cualitativa se limita al mundo académico sin que necesariamente implique que la comunidad se pueda beneficiar de ella como sucede en el caso de la investigación para la acción

Although in recent years there has been a growing acceptance of qualitative research in social epidemiology, the role and scope of its use remain a contested terrain. We sketch some of the issues that have been the focus of the debate between supporters and critics of qualitative research in social epidemiology and adjacent public health disciplines. They include epistemological problems, such as the limitations of survey research to uncover social mechanisms, lack of background among epidemiologists to generate sound hypotheses for specific populations, and ontological problems such the idealism inherent in some of the qualitative research coming from anthropology. Next we review the urban ethnographies of Elliot Liebow's and a decade of population based research in African American and low income neighborhoods in the United States to expose another role for qualitative research in social epidemiology. Thus, we argue that qualitative research has been used in scientific debates that confront egalitarian researchers with institutions or peers with opposing economic interests and ideologies. Qualitative research is often a powerful tool to fuel alternative theoretical frameworks and measures to be included in quantitative population based surveys. We confine this use of qualitative research to the academic world and do not necessarily imply that communities benefit from it as in action research

Salmonella: comparación de dos métodos para su detección en alimentos para aves / Comparison of two methods for detection of Salmonella in broiler feed

El método de hibridación colorimétrico de Gene Traktm (GENE TRAK Systems, 31 New York Avenue, Framingham, M.A.) fue comparado con la metodología convencional propuesta por International Commission for Microbiological Standard Foods (ICMSF) en la detección de Salmonella en muestras de alimentos balanceados y materias primas de origen animal y vegetal utilizadas en la formulación de los mismos. Se procesaron 249 muestras que incluyen muestras inoculadas y 9 muestras no inoculadas. De un total de 240 muestras no inoculadas, 62,9 por ciento no acusaron presencia de Salmonella por ningún método, 27,9 por ciento fue positivo por ambos métodos y el 9,2 por ciento dio positivo por Gene Trak no pudiéndose confirmar después de cinco determinaciones por el método convencional. Esta metodología se presenta como un método interesante de detección con importantes ventajas frente al convencional: facilidad para procesar un gran número de muestras sin despliegue de gran cantidad de material, acortamiento del tiempo en obtener resultados y alta sensibilidad(AU)

Salmonella: comparación de dos métodos para su detección en alimentos para aves / Comparison of two methods for detection of Salmonella in broiler feed

El método de hibridación colorimétrico de Gene Traktm (GENE TRAK Systems, 31 New York Avenue, Framingham, M.A.) fue comparado con la metodología convencional propuesta por International Commission for Microbiological Standard Foods (ICMSF) en la detección de Salmonella en muestras de alimentos balanceados y materias primas de origen animal y vegetal utilizadas en la formulación de los mismos. Se procesaron 249 muestras que incluyen muestras inoculadas y 9 muestras no inoculadas. De un total de 240 muestras no inoculadas, 62,9 por ciento no acusaron presencia de Salmonella por ningún método, 27,9 por ciento fue positivo por ambos métodos y el 9,2 por ciento dio positivo por Gene Trak no pudiéndose confirmar después de cinco determinaciones por el método convencional. Esta metodología se presenta como un método interesante de detección con importantes ventajas frente al convencional: facilidad para procesar un gran número de muestras sin despliegue de gran cantidad de material, acortamiento del tiempo en obtener resultados y alta sensibilidad