Testing a digitally distributed method to recruit a network of community organizations to fight the consequences of the drug epidemic: A study in 13 American states.

To mitigate the opioid epidemic, a concerted effort to educate, prevent, diagnose, treat, and engage residents is required. In this study, a digitally distributed method to form a large network of organizations was tested with 99 counties in regions with high vulnerability to hepatitis C virus (HCV). The method involved a cascade of contacts going from email to phone calls, to videoconferencing and measuring the number of contacts required, amount of time taken, and the proportion of success at recruiting at least one community organization per county. A recruitment period of 5 months and 2118 contact attempts led to the recruitment of organizations from 73 out of our 99 target counties. Organizations belonging to health departments required more attempts and time to recruit but ultimately enrolled at higher rates than did other organizations such as coalitions and agencies. Organizations from counties more (vs. less) vulnerable to HCV outbreaks required more attempts to recruit and, using multiple recruitment methods (e.g., emails, phone calls, and Zoom meetings), improved enrollment success. Overall, this method proved to be successful at remotely engaging a large-scale network of communities with different levels of risk within a large geographic region.

Discrimination and Health among Lesbian, Gay, Bisexual and Trans People in Puerto Rico.

OBJECTIVE: To identify the experiences of discrimination among and the perceived priorities for the health of lesbian, gay, bisexual, and trans (LGBT) people in Puerto Rico (PR). METHODS: Data were collected during the 2013 LGBT Pride Parade in San Juan, using a brief self-administered survey that included questions on sociodemographic characteristics, the disclosure of sexual orientation/gender identity, experiences of discrimination, experiences while receiving social and health services, and perceived healthcare priorities and needs. RESULTS: Most participants reported that they had disclosed their sexual orientation to at least one person. Discrimination due to sexual orientation/gender identity was most frequently reported to have occurred in school settings. At least 25% of the sample reported regular or negative experiences based on sexual orientation/gender identity when receiving government services and when looking for support from relatives. HIV/AIDS, mental health, and sexual health were identified as healthcare priorities. In bivariate analyses, mental health services and aging were the priorities most frequently reported among older participants. HIV/AIDS was the main priority only for gay men; sexual health was the main priority for bisexuals; and mental health was the main priority for lesbians. Most participants reported that their preferred modalities for health service provision were support groups and health education. CONCLUSION: The experiences of discrimination among LGBT people in PR were consistent across age groups and sexual orientation/gender identity. Policies and interventions to address discrimination in different settings are necessary. The findings also suggest the need to prioritize HIV services among gay men and to address mental and sexual health needs among lesbian and bisexual people.

Sexual health and socioeconomic-related factors among HIV-positive men who have sex with men in Puerto Rico.

Most of the research among HIV-positive populations has been approached from behavioral risk models. This is particularly true for those otherwise socially vulnerable groups like men who have sex with men (MSM). As a response to this pattern, we examined data from an ongoing health promotion research being conducted in Puerto Rico (PR). The study is limited to HIV-positive MSM and consists of the participation in a survey interview that includes domains used to assess indicators of socio-economic-related factors (age, educational level, employment, religion, and partnership status) and sexual health (sexual satisfaction, condom use, and sexual health knowledge(SHK)). Participants reported a relatively high level (75 %) of sexual satisfaction and inconsistent condom use (50.9 % reported always using a condom). A deficient (61 %) SHK was also reported. In multivariate analyses, a higher educational level was associated with higher sexual satisfaction (aß = 3.223; 95 % CI 0.291-6.156) and higher levels of SHK (aß = 1.328; 95 % CI 0.358-2.297), while unemployment was associated with less condom use (aOR 0.314; 95 % CI 0.122-0.810). Not having a primary sexual partner was associated with less sexual satisfaction (aß = -3.871; 95 % CI -7.534-0.208) and more condom use (aOR 4.292; 95 % CI 1.310-14.068). Findings support the notion that men of a disadvantaged socioeconomic position may have a poorer sexual health status; with a lower level of education and unemployment leading this disparity. Findings also evidence that partnership status may have a role in the sexual health of HIV-positive MSM. To our knowledge, this is the first comprehensive analysis of sexual health and socioeconomic indicators among Hispanic/Latino HIV-positive MSM in PR and in the Caribbean. Findings provide valuable information to address the sexual health needs of an underserved population.

Impaired Endogenous Neurosteroid Signaling Contributes to Behavioral Deficits Associated With Chronic Stress.

BACKGROUND: Chronic stress is a major risk factor for psychiatric illnesses, including depression. However, the pathophysiological mechanisms whereby stress leads to mood disorders remain unclear. Allopregnanolone acts as a positive allosteric modulator preferentially on δ subunit-containing GABAA (gamma-aminobutyric acid A) receptors. Accumulating clinical and preclinical evidence supports the antidepressant effects of exogenous administration of allopregnanolone analogs; yet, the role of endogenous allopregnanolone in the pathophysiology of depression remains unknown. METHODS: We utilized a chronic unpredictable stress (CUS) mouse model, followed by behavioral and biochemical assays, to examine whether altered neurosteroid signaling contributes to behavioral outcomes following CUS. We subsequently performed in vivo CRISPR (clustered regularly interspaced short palindromic repeats) knockdown of rate-limiting enzymes involved in allopregnanolone synthesis, 5α-reductase type 1 and 2 (5α1/2), in addition to lentiviral overexpression of 5α1/2 in the basolateral amygdala (BLA) of mice that underwent CUS to assess the impact of 5α1/2 on behavioral outcomes. RESULTS: The expression of δ subunit-containing GABAA receptors and endogenous levels of allopregnanolone were reduced in the BLA following CUS. Treatment with an exogenous allopregnanolone analog, SGE-516, was sufficient to increase allopregnanolone levels in the BLA following CUS. Knockdown of 5α1/2 in the BLA mimicked the behavioral outcomes associated with CUS. Conversely, overexpression of 5α1/2 in the BLA improved behavioral outcomes following CUS. CONCLUSIONS: Our findings demonstrate that chronic stress impairs endogenous neurosteroid signaling in the BLA, which is sufficient to induce behavioral deficits. Further, these studies suggest that allopregnanolone-based treatments may directly target the underlying pathophysiology of mood disorders suggesting that targeting endogenous neurosteroidogenesis may offer a novel therapeutic strategy.

Sexual health knowledge and stigma in a community sample of HIV-positive gay, bisexual and other men who have sex with men in Puerto Rico.

Gay, bisexual and other men who have sex with men (GBMSM) are at increased risk for HIV infection and disease progression. Also, HIV-positive GBMSM are among those less likely to be retained in care. In this study we analyzed sexual health knowledge (SHK) and various manifestations of stigma in a community sample of HIV-positive GBMSM in Puerto Rico. The sample reports overall low SHK scores, and lower score were associated with low educational attainment, unemployment, low income, and with self-identifying heterosexual participants. Almost half of the sample reported moderate to severe perceived gay stigma, 68.4% reported moderate to severe hidden-gay stigma, and 30.6% reported moderate to severe HIV-felt stigma. Further research is recommended to obtain culturally congruent information and develop interventions addressing the multiple layers of stigma in the social context where the interventions will be delivered.

Fractura supracondílea de húmero y extremidad sin pulso. Uso de oximetría de pulso como predictor de lesión vascular en un caso pediátrico / Pulseless limb and supracondylar humeral fracture; use of pulse oximetry as a predictor of vascular injury in a pediatric case

Las fracturas supracondíleas del húmero (FSCH) representan la segunda lesión más frecuente en la infancia. La clasificación de Gartland, de acuerdo con la dirección y magnitud del desplazamiento orienta hacia su tratamiento. Las fracturas grado I solo requieren inmovilización y los grados del II al IV necesitan reducción generalmente cerrada, y fijación con agujas de Kirschner percutáneas. En los grados III y IV las lesiones neuro-vasculares se pueden presentar debido a las relaciones anatómicas de la fractura. La lesión vascular se debe sospechar y tener siempre en cuenta, debido a las secuelas que se pueden presentar de no tomar una conducta adecuada a tiempo. Actualmente existe controversia acerca de cuándo realizar la exploración quirúrgica ante una extremidad bien perfundida, sin pulso radial como resultado de una FSCH. Varios autores han reportado la utilidad de la onda de pulso en la oximetría como predictor de lesión vascular. En este artículo se presenta un caso clínico de FSCH con extremidad sin pulso y lesión de la arteria braquial, su manejo y evolución final.

Supracondylar fractures of the humerus are the second most frequent lesion of infancy. Gartland's classification uses the direction and magnitude of the displacement to determine its treatment. Grade I fractures need only immobilization and grades II to IV need reduction, generally closed, and percutaneous fixation with Kirschner needles. Neurovascular lesions may be present in grades III and IV because of the anatomic relations to the fracture. Vascular injury must always be suspected and taken into consideration because of the sequelae that may occur if not given adequate treatment promptly.There is currently controversy over when to do a surgical exploration in a well-perfused limb with absent radial pulse resulting from a supracondylar humeral fracture. Several authors have reported the usefulness of the waveformof the pulse oximeter in predicting vascular injury. In this article we present a clinical case of supracondylar humeral fracturewithpulseless limb and brachial artery injury, its management, and the outcome.

Neuro-oftalmo-criptococosis en dos pacientes con SIDA / Neuro-ophthalmo-cryptococcosis in 2 patients with AIDS

La criptococosis es una causa importante de morbimortalidad en pacientes con Sida. Es la infección oportunística que ocurre en segundo lugar de frecuencia a nivel oftalmológico, después de la retinitis a citomegalovirus. Un 40 por ciento de los pacientes afectados de criptococosis meníngea presentan compromiso ocular. Se describen dos casos clínicos de compromiso neurooftalmológico con evolución fatal. Se analizan las manifestaciones clínicas, así como los exámenes diagnósticos pertinentes y aspectos terapéuticos

Disgenesias papilares y de retina: incluyendo un caso de papila contráctil y uno de enfermedad de Norrie / Disc and retina disgenesia: including a contractil papilla and 1 of Norrie`s disease

Se presentan 21 ojos con anomalías congénitas de papila y retina, detallando un caso de disgenesia papilar total o síndrome de Morning Glory, de tipo contráctil que evolucionó hacia una PVR masiva, y un caso de displasia retinal o Enfermedad de Norrie típicamente bilateral. Se discute la embriogénesis de estas anomalías, concluyendo que la displasia retinal ocurre en la sexta semana de gestación y que la disgenesia papilar total probablemente se sitúe en la cuarta semana gestacional, produciéndose por falta de obliteración de la copa óptica

Conocimientos y actitudes de la sexualidad en profesores de la provincia de Chañaral / knowledge and attitudes about sexuality among teachers of Chañaral province

Los autores, médicos de dos hospitales de la III Región (Norte de Chile), estudian en profesores de enseñanza básica y media (144), de ambos sexos, de las localidades donde trabajan, el nivel de conocimientos sobre sexualidad humana. Se pretende con ello determinar el grado de adecuación de las actitudes en torno a la sexualidad de sus alumnos, la existencia de creencias erróneas y la opinión sobre fuentes de información y educación sexual. Los 144 profesores representan el 80% de los existentes. El 20% restante se encontraba ausente. 59% son de sexo masculino y 41% femenino, los que se agrupan en 70.1% entre 20 y 35 años, 27,7 entre 36 y 50 y 4,2% entre 50 y más años, con una dispersión entre 24 y 51 años. El cuestionario contempla conceptos de sexualidad, conocimientos de anatomía y fisiología sexual, de aspectos psico-sexuales y de métodos anticonceptivos. En cada uno de los ítems sobre sexualidad, alrededor del 25% de los profesores se abstiene de contestar, situación que llega al 43,7% frente a la definición de líbido. La proporción de respuestas inadecuadas supera el 50% para definir sexualidad, pubertad y adolescencia. Sumadas las abstenciones y las respuestas erróneas, en todos los ítems se supera el 80%, exceptuando el orgasmo que tiene un 50% de respuestas correctas. En conocimiento de anatomía de los órganos genitales, llama la atención que resulte mucho más conocido el aparato reproductor femenino que el masculino (62,9% vs. 37,1%) y el-aparato genital externo del hombre que el de la mujer. En, conocimientos de fisiología, el 33% responde en forma errada y el 67% se abstiene. En cuanto a las etapas del desarrollo psicosexual, el 98% no responde o lo hace mal y sólo el 2% lo hace adecuadamente...