Systemic Challenges in Internship Training for Health-Service Psychology: A Call to Action From Trainee Stakeholders.

The challenges observed in health service psychology (HSP) training during COVID-19 revealed systemic and philosophical issues that preexisted the pandemic, but became more visible during the global health crisis. In a position paper written by 23 trainees across different sites and training specializations, the authors use lessons learned from COVID-19 as a touchstone for a call to action in HSP training. Historically, trainee voices have been conspicuously absent from literature about clinical training. We describe longstanding dilemmas in HSP training that were exacerbated by the pandemic and will continue to require resolution after the pandemic has subsided. The authors make recommendations for systems-level changes that would advance equity and sustainability in HSP training. This article advances the conversation about HSP training by including the perspective of trainees as essential stakeholders.

Lynx eats cat: disease risk assessment during an Iberian lynx intraguild predation.

Lethal interactions between members of the carnivore guild are well represented in literature. In the Iberian lynx, interspecific killing (without prey consumption) of some mesocarnivores, such as the Egyptian mongoose, genet, and red fox, has been reported. Although vaguely documented, evidence suggests feral cats fall victim to interactions with this apex predator. Here, we describe the first documented case of interspecific killing and partial consumption of a feral cat by an adult male Iberian lynx reintroduced in Southwestern Spain. Ulterior analyses demonstrated that the victim was viremic to feline leukemia virus. To prevent the dissemination of the virus and a potential outbreak in the Iberian lynx population, control measures, including the clinical evaluation of the male Iberian lynx, and intensive monitoring were implemented in order to detect intraspecific interactions. After 3 weeks, the lynx was evaluated, presented good condition and resulted negative to both ELISA and RT-PCR. Thanks to the long-term monitoring, this case could be detected and measures to prevent an outbreak could be implemented.

[In-depth interviews and the Kano model to determine user requirements in a burns unit]. / La entrevista en profundidad y la metodología Kano para conocer los requisitos de los usuarios en una unidad de quemados.

OBJECTIVE: To determine the healthcare requirements of patients in a Burns Unit, using qualitative techniques, such us in-depth personal interviews and Kano's methodology. MATERIAL AND METHODS: Qualitative methodology using in-depth personal interviews (12 patients), Kano's conceptual model, and the SERVQHOS questionnaire (24 patients). All patients had been hospitalised in the last 12 months in the Burns Unit. Using Kano's methodology, service attributes were grouped by affinity diagrams, and classified as follows: must-be, attractive (unexpected, great satisfaction), and one-dimensional (linked to the degree of functionality of the service). The outcomes were compared with those obtained with SERVQHOS questionnaire. RESULTS: From the analysis of in-depth interviews, 11 requirements were obtained, referring to hotel aspects, information, need for closer staff relationship, and organisational aspects. The attributes classified as must-be were free television and automatic TV disconnection at midnight. Those classified as attractive were: individual room for more privacy, information about dressing change times in order to avoid anxiety, and additional staff for in-patients. The results were complementary to those obtained with the SERVQHOS questionnaire. CONCLUSIONS: In-depth personal interviews provide extra knowledge about patient requirements, complementing the information obtained with questionnaires. With this methodology, a more active patient participation is achieved and the companion's opinion is also taken into account.

Tagetes lucida Cav.: Ethnobotany, phytochemistry and pharmacology of its tranquilizing properties.

ETHNOPHARMACOLOGICAL RELEVANCE: Morelos State is one of the most important regions of Mexico where several plant species are used in traditional medicine to influence central nervous system (CNS) activity; for example Tagetes lucida Cav. AIM OF THE STUDY: To investigate the ethnobotany, phytochemistry and pharmacology of the tranquilizing properties of T. lucida aerial parts. MATERIAL AND METHODS: Data on the medicinal uses of T. lucida were explored by interviewing healers and merchants of local markets in different regions of Morelos State by using a questionnaire. Anxiolytic and/or sedative-like responses of the T. lucida were investigated in experimental models in mice such as: open-field, exploration cylinder, hole-board, plus-maze, and the barbituric-induced hypnosis potentiation. The possible mechanism of action was explored in the presence of WAY100635 (0.32mg/kg, i.p.) and flumazenil (10mg/kg, i.p.) antagonists. A feasible active compound was isolated and identified by using conventional chromatography, including UHPLC and MS (DART) [M+H]+ techniques. RESULTS: Interviews of healers and merchants from ten local regions of Morelos State showed that they recommended T. lucida as infusion and as tincture for several culture-bound syndromes associated with the CNS. Anxiolytic and sedative-like activities of polar extracts were corroborated in the experimental models; these effects were inhibited in the presence of 5-HT1A and GABA/BDZ receptor antagonists. Dimethylfraxetin was identified as one possible active compound. CONCLUSIONS: The results support the anxiolytic and sedative-like properties of T. lucida in traditional medicine by involving serotonergic and GABAergic neurotransmission and coumarinic constituents.

Clinical assessment and health-related quality of life in patients with non-cardiac chest pain.

INTRODUCTION: Non-cardiac chest pain (NCCP) is mainly related to oesophageal disease, and in spite of being a common condition in Mexico, information regarding it is scarce. AIM: To assess the clinical characteristics and health-related quality of life of patients with NCCP of presumed oesophageal origin. MATERIAL AND METHODS: Patients with NCCP of presumed oesophageal origin with no previous treatment were included in the study. Associated symptoms were assessed and upper gastrointestinal endoscopy and 24-hour oesophageal pH monitoring were performed to diagnose gastroesophageal reflux disease, while oesophageal manometry was used to determine oesophageal motility disorders. The SF-36 Health-Related Quality of Life (HR-QoL) questionnaire was completed and its results compared to a control group without oesophageal symptoms. RESULTS: The study included 33 patients, of which 61% were women, and the mean age was 46.1 (±11.6) years. Causes of NCCP were gastroesophageal reflux disease in 48%, achalasia in 34%, and functional chest pain in 18%. The average progression time for chest pain was 24 (2-240) months, with ≤ 3 events/week in 52% of the patients. The most frequent accompanying symptoms were: regurgitation (81%), dysphagia (72%) and heartburn (66%). Patients with NCCP show deterioration in HR-QoL compared to the control group (P=.01), regardless of chest pain aetiology. The most affected areas were general perception of health, emotional issues, and mental health sub-scale (P>0.05). CONCLUSIONS: In our population, patients with NCCP show deterioration in HR-QoL regardless of the aetiology, frequency, and accompanying symptoms.

Alcohol drinking patterns and differences in alcohol-related harm: a population-based study of the United States.

Alcohol use and associated alcohol-related harm (ARH) are a prevalent and important public health problem, with alcohol representing about 4% of the global burden of disease. A discussion of ARH secondary to alcohol consumption necessitates a consideration of the amount of alcohol consumed and the drinking pattern. This study examined the association between alcohol drinking patterns and self-reported ARH. Pearson chi-square test (χ (2)) and logistic regression analyses were used on data from the National Comorbidity Survey Replication (NCS-R). The NCS-R is a cross-sectional nationally representative sample. Data was obtained by face-to-face interviews from 9282 adults aged ≥ 18 years in the full sample, and 5,692 respondents in a subsample of the full sample. Results presented as odds ratio (OR) and 95% confidence intervals (95% CI). Alcohol drinking patterns (frequency of drinking, and drinks per occasion) were associated with increased risks of self-reported ARH; binge or "risky" drinking was strongly predictive of ARH than other categories of drinks per occasion or frequency of drinking; and men had significantly higher likelihood of ARH in relation to frequency of drinking and drinks per occasion. Findings provide evidence for public health practitioners to target alcohol prevention strategies at the entire population of drinkers.

Assessment of virulence factors characteristic of human Escherichia coli pathotypes and antimicrobial resistance in O157:H7 and non-O157:H7 isolates from livestock in Spain.

The distribution of virulence factors (VFs) typical of diarrheagenic Escherichia coli and the antimicrobial resistance (AMR) profiles were assessed in 780 isolates from healthy pigs, broilers, and cattle from Spain. VF distribution was broader than expected, although at low prevalence for most genes, with AMR being linked mainly to host species.

Short and valid assessment of apraxia in Parkinson's disease.

BACKGROUND: Valid assessment of apraxia in usually non-apraxic Parkinson's disease helps to delineate atypical parkinsonism frequently associated with apraxia. Furthermore, in a subgroup of late Parkinson's disease apraxia, typically the ideomotor subtype, may gradually superimpose onto parkinsonian motor symptoms contributing to defective manual skill. Here we evaluate the utility of a brief, standardized test, the apraxia screen of TULIA (AST). METHODS: Seventy five Parkinson's disease patients were tested with the AST. Parkinsonian motor deficits were measured using Movement Disorders Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS) part III and difficulties in activities of daily living (ADL) by modified MDS-UPDRS part II (eating, dressing, personal hygiene, and writing). RESULTS: No association was found between the AST and MDS-UPDRS part III, indicating that AST discriminates well (discriminative validity) between apraxia and parkinsonism. Furthermore, AST was associated with ADL and Hoehn & Yahr stage (convergent validity). CONCLUSIONS: AST is a short and valid test to rule out or detect apraxia in Parkinson's disease.

Assessment of the nitrogen correction factor in evaluating metabolizable energy of corn and soybean meal in diets for broilers.

Three experiments were carried out to determine AME and AMEn of corn and soybean meal (SMB) in diets for growing broilers. In experiments 1 and 2, ingredient-specific basal diets or a combination of these basal diets with corn and SBM were prepared. For corn, the substitution was 25, 50, or 75% of the total diet, whereas SBM substitution was at 10, 20, or 30%. In experiment 1, birds were fed the experimental diets continuously from 0 to 33 d, and AME and AMEn were determined during 9 to 12 d and 30 to 33 d of age. In experiment 2, birds were fed the experimental diets only around the time of the collection period. The AMEn of corn was 95 to 97% of corresponding AME, whereas for SBM, AMEn was 93 to 88% of AME. Linear regression was used as an alternative method of calculating ingredient energy values resulting in a significant regression of diet AME and AMEn content on inclusion level, for each period of time and for each ingredient (corn and SBM). Based on varying inclusion levels of test ingredients in the diet, the extrapolated AME and AMEn of corn were estimated more precisely (R2 = 0.90 to 0.95) than those of SBM (R2 = 0.57 to 0.85), suggesting that the variability of AME and AMEn is better explained by a linear regression of AME or AMEn on percentage of inclusion. For corn, AME and AMEn were little affected by age, and the effect of N correction was consistent at around 3%. Determined energy values of SBM were more variable. Experiment 3 was conducted to assess the effect of formulating diets based on either AME or AMEn on broiler performance. A 2-sample t-test was implemented examining AME vs. AMEn formulation. The analyses for numerous production and carcass traits were nonsignificant except for the case of less abdominal fat in birds fed diets formulated to AME rather than AMEn (P < 0.01). These results showed that the use of the N correction imposed a penalty to corn of 3 to 5% and SBM of 7 to 12%.

[Valuation of APRI and Forns models for non-invasive diagnosis of fibrosis in patients with hepatitis C in coinfected and non-coinfected with HIV]. / Valoración de los modelos APRI y Forns para el diagnóstico no invasivo de fibrosis en pacientes con hepatitis C coinfectados y no coinfectados por VIH.

BACKGROUND: APRI and Forns (IF) index are noninvasive models consisting of routine laboratory data for the prediction of liver fibrosis in patients with chronic hepatitis C. The aim of our study was to confirm the value of these models to predict significant fibrosis in these patients and if they may decrease the need for performing liver biopsy specimens in coinfected and HIVnon-coinfected. PATIENTS AND METHOD: We included 60 patients with chronic hepatitis C and histologic data, 33 were coinfected with HIV. Mild fibrosis (F0-F1) was found in 73% patients, severe fibrosis (F3-F4) in 23% and cirrhosis in 18.3%. We calculated and compared APRI and IF with the stage of liver fibrosis. RESULTS: The APRI score < 0.5 or > 1.5 and IF < 4.2 or > 6.9, as predictors of mild or severe fibrosis, were only available in 53% and 49%. Neither laboratory nor APRI and IF were associated with liver fibrosis in non-coinfected patients. We only found association in HIV coinfected patients: severe fibrosis (F3-4) whit higher gammaglobulins [24.5% vs. 30% (p < 0.05)] and Gamma-GT levels [77 (46.5) vs. 32 (48.5) (p < 0.05)], and lower prothrombin time [72% vs. 91% (p < 0.05) ] and platelets.109 count [129 (40) vs. 170 (78) (p < 0.05)]; APRI was lower than 0.5 in 41.6% patients with mild fibrosis (F0-1) against none with severe (F3-4) (p < 0.05); specifity (E) of APRI < 0.5 for predicting mild fibrosis was 100%, but sensivity (S) was very low (41%), with a positive preditive value (VPP) of 100%, but a negative predictive value (VPN) also very low ( 36.3%). CONCLUSIONS: Our study showed that these models don t avoid the need for liver biopsies. More than a half of patients are not appropriately classified according to findings on liver biopsy and S and VPN are very low. The combination of these index with gammaglobulins, Gamma-GT, AST, ALT and platelet levels and protrombine time, only may be an approach to degree of fibrosis or inflammation liver in HIV co-infected patients.

Relevance of nitrogen correction for assessment of metabolizable energy with broilers to forty-nine days of age.

An experiment was conducted to reevaluate the concept of using AME vs. AME(n) values for broiler diets. Growing male broilers and adult Leghorn roosters were fed either a single standard diet from 0 to 49 d or a series of starter (0 to 21 d), grower (21 to 35 d), and finisher (35 to 49 d) diets. Apparent ME and AME(n) were determined during 4 to 7, 11 to 14, 18 to 21, 25 to 28, 32 to 35, 39 to 42, and 46 to 49 d of age. Using the single diet after 7 d, the broiler consistently derives higher AME than do roosters. This same effect was seen with the multiple diet series for broilers. However when N correction is applied, the converse situation is seen, in that roosters consistently attain higher AME(n) than do broilers at any given age. Using a single diet, rooster AME and AME(n) values were unaffected by time, whereas broilers exhibit a quadratic relationship for both AME and AME(n) through 49 d. Nitrogen retention of roosters was rarely different from zero (P > 0.05). For broilers, there was a significant (P < 0.01) increase in grams of N retained each day over time, although when expressed as a percentage of N intake, there was decline over time, especially after 28 d of age. The N correction imposes a 4 to 5% reduction on the AME value of a single diet. When a commercial series of diets was used, the correction declined from 5.3% at 7 d to 3.8% at 49 d, reflecting the decline in protein content of the diet and the decline in N retention over time. This information suggests that if AME rather than AME(n) values are accepted, then roosters provide a good estimate of values applicable for broiler nutrition, because values are little different. Because there was less variance in energy values expressed as AME(n) rather than AME, it appears that there was sufficient bird-to-bird variation in growth, N retention, or both, to warrant the use of the correction factor.

Critical assessment of the methods used for detection of bacterial translocation.

AIM: Bacterial translocation (BT) can be demonstrated by blood and lymph node cultures and also by polymerase chain reaction (PCR) detection of DNA of enteric bacteria. Aiming at investigating BT after gastrointestinal operations we assessed it on two endpoints after ischemia-reperfusion (IR) or sham operation (SO). METHODS: 2 groups of 200-g Brown Norway male rats were treated as follows: SO animals ( n=12) had laparotomy alone and IR animals ( n=12) had successively 15 min clamping of the portal vein and the mesenteric artery. Half the animals in each group were killed on postoperative (p.o.) day 2 the other half on p.o. day 7. Under sterile conditions regional lymph nodes and vena cava and portal vein blood samples were recovered and cultured for aerobes and anaerobes. Escherichia coli beta-galactosidase DNA was assessed in blood samples by PCR. The findings in the two groups were compared by means of chi(2) tests. RESULTS: Post-hepatic (peripheral blood) BT was detected by cultures of gram-negative bacteria in 16% and 0% of SO and IR animals, respectively, on p.o. day 2 and in 16% and 50% on p.o. day 7. These differences were not significant (ns). E. coli DNA was found in one SO rat. Pre-hepatic BT (portal blood and/or lymph nodes) of gram-negative bacteria was found in 16% and 33%, respectively, on day 2 and in 16% and 16% on day 7 (ns). However, if gram-positive cultures were taken into account, the figures were 66% and 66% on day 2 and 66% and 83% on day 7 (ns). No anaerobes could be cultured. CONCLUSIONS: (1) BT is frequent in surgically manipulated animals. (2) To limit the assessment of BT to Enterobacteriaceae is probably misleading, since consistent amounts of gram-positive bacteria are found in the pre-hepatic territory. (3) PCR tests limited to E. coli DNA alone are likely incomplete. (4) Short periods of vascular clamping do not increase BT on the two endpoints selected in comparison with SO animals.

[Cytogenetical prenatal diagnosis by amniocentesis during the II and III gestation trimesters in Costa Rica]. / Diagnóstico prenatal citogenético mediante amniocentesis durante los trimestres II y III de gestación en Costa Rica.

The identification of fetal abnormal chromosomes in high risk pregnancies allows proper pediatric and obstetric management of the cases as well as genetic counseling. The results of 842 genetic amniocentesis from 1986 to 1999 are reported. All procedures were performed transabdominally and under ultrasound guidance, in hospitals of the social security system and in private facilities. There were two main reasons for referral: abnormal ultrasound assessment (48% of cases) and advanced maternal age (35%). Most procedures (66%) were performed during the second trimester of pregnancy and 34% during the third trimester. Fetal cells were closed cultured and suspension harvested. Median turn around time was 14 days. In 217 amniotic fluid samples no diagnosis could be obtained, mainly due to absence of cell growth in late gestation samples or because of blood contamination. Of 625 fetal karyotypes 55 (9%) were abnormal, due to 33 trisomies (including a Robertsonian translocation trisomy 13), eight cases of monosomy X, three mosaics (including a mosaic trisomy 22), balanced and unbalanced translocations, extra structurally abnormal chromosomes and other defects. Pseudomosaicism was detected in five cases. Taking into account the reason for referral, cases studied as a result of abnormal ultrasound assessment exhibited 17% abnormal karyotypes, in contrast to 2.5% cytogenetic defects in pregnancies of women 35 years or older. Prenatal cytogenetic and sonographic findings correlated with the phenotype of the newborn in 211 cases available for follow-up. Prenatal diagnosis of fetal defects allowed genetic counseling as well as better obstetric management and pediatric care. Normal results of both tests provided reassurance to prospective parents.

Incidence, risk and evolution of ostheoporotic hip fractures in Spanish women using a Markov type model. / Incidencia, riesgo y evolución de las fracturas osteoporóticas de cuello de fémur en las mujeres en España, a partir de un modelo de Markov.

BACKGROUND: To estimate osteoporotic hip fracture incidence rates, by age and gender, and lifetime fracture risk of women of different age groups over 45 in Spain, and to determine the expected number of fractures and fracture-related person-years of functional impairment, as a basis for estimating the social costs of osteoporosis in Spain and the avoided costs of fractures in future cost-effectiveness analyses. MATERIAL AND METHODS: The natural history of disease, recognized from fractures, is described using a Markov model and MonteCarlo simulations. Four cohorts of 10,000 women, each of a different age group, were simulated. Data were obtained from six hospitals of different size and geographical setting, to allow for differences in hospital service structure. Patients included were all new cases of hip fracture who were attended in those hospitals in 1995. Results are extrapolated to the Spanish population based on 1991 census. RESULTS: We can predict in the group of women aged 50 an over in Spain 968,000 osteoporotic hip fractures during their remaining lifetime, with a total amount of 1,013,000 fractures. Some 135,000 will become functionally impaired due to the fractures, accounting for 1,177,000 person-years of functional impairment. CONCLUSIONS: The study provides a prototype for estimating avoided costs of fractures in future cost-effectiveness analyses.

[Development and evaluation of food supplements for the education, health, and nutrition program]. / Desarrollo y evaluación de suplementos alimenticios para el programa de educación, salud y alimentación.

OBJECTIVE: To develop and evaluate nutritional supplements destined to a program of social assistance. MATERIAL AND METHODS: In the design of the nutritional supplements a series of criteria were considered including nutrient composition, physicochemical properties and feasibility of production and utilization. Final products were initially evaluated to determine the level of acceptance in 40 children, 52 pregnant women and 62 lactating women in Mexico City. A community trial was also carried out to determine acceptance and consumption in 108 children and 128 women from a rural community in the state of Morelos. RESULTS: The specific formulation and technical processes of production of the nutritional supplements are presented. Products proved to be widely accepted, with average scores of 4.11-4.29 for the children's beverage, and 3.98-4.15 for a more viscous pap (range of scores was 1 to 5). Products for women received average scores from 4.75 to 5.70 in pregnant and from 4.8 to 5.4 in lactating women (range of scores from 1 to 7). In the community trial, supplements were very well accepted. Average consumption was > 75% among children and > 98% among women. Mean energy intake from supplements was 244 Kcal/day for women, and for children, 168 Kcal/day with the pap and 147 Kcal/day with the beverage. Consumption was consistent in all cases along the study. CONCLUSIONS: Nine nutritional supplements were developed and evaluated which comply with the necessary nutritional, physicochemical and hygienic characteristics for the target population, besides being relatively simple to prepare, and widely well accepted and consumed.

Texas public school nurses' assessment of children's oral health status.

Researchers investigated the amount and types of dental morbidity that Texas public school nurses observed in an average school week. Two thousand nurses were randomly selected and surveyed by mail with 54% responding. Respondents reported 3.5% of the student population sought the nurses' services for a dental problem. Twelve school nurses reported that, of all health problems they observed, more than 50% were dental-related. Approximately 48% indicated oral health screenings occurred at least once every other year. Data suggest children are suffering dental problems that could possibly be detected and treated by oral health screenings, thus preventing more serious morbidity. As part of the Texas public school admissions protocol, like required immunizations, children suffering dental problems could be referred for preadmission oral examinations to identify early any dental problems, and thus improving the children's oral health and preventing school absenteeism.

[Perception of the quality of care in the health services in Mexico. perspective of the users]. / Percepción de la calidad de la atención de los servicios de salud en México: perspectiva de los usuarios.

OBJECTIVE: To describe the quality of health services as perceived by users in Mexico, as well as an analysis of predisposing and enabling factors to the use of these services. MATERIAL AND METHODS: Data were selected from the National Health Survey II of 1994. The survey contains information from 3324 ambulatory health service users who sought care in the two week period previous to the survey. RESULTS: 81.2% of users perceived the quality as good and 18.8% thought it was poor. The main reasons for good quality of care were: personal attention (23.3%) improvement of the health problem (11.9%). For poor quality of care, the main reasons were: long waiting time (23.7%) and poor clinical examination (11.7%) Social security health service users perceived 2.6 times more frequently quality of attention as poor, than those who consulted private health services. Quality is represented by the aspects of the attention process (44.8% 9, its results (21.3%), the structure (18.0%) and accessibility (15.7%) The main reasons for not returning to the same health service center were: deficient attention (18.2%) and long waiting times (11.8%). CONCLUSIONS: The perspective of the population should be studied further and actions for the continuous improvement of the quality of health care should be implemented.

Assessment of learning by emergency medicine residents and pharmacy students participating in a poison center clerkship.

An AAPCC-designated poison center developed and validated an objective testing instrument to evaluate learning during a poison center clinical rotation for 2nd-year emergency medicine residents and 5th-year pharmacy students. The examination contained multiple-choice, true-false, and fill-in questions pertaining to basic clinical toxicology. A pretest was administered prior to the rotation and a post-test was administered upon completion of the rotation. Overall pre-test mean was 56.2%; physician pre-test mean was 73.8%, and student pre-test mean was 43.9%. Overall post-test mean was 78.7%; physician post-test mean was 85.7%, and student post-test mean was 81%. Pre-test scores ranged from 21 to 86% for the group, and post-test scores ranged from 68 to 96%. The mean difference in pre-test to post-test score was 26.9%. These data suggest that a poison center rotation can result in significant increases in post-test scores in comparison to pre-test scores.

[Detection of HIV antibodies in pooled sera]. / Detección de anticuerpos al VIH en mezclas de sueros.

The use of sera mixtures for the detection of HIV antibodies was studied in a population of low prevalence (0.006%), using the diagnosis systems of national production: Recombinant HIV UMELISA and RECHIV 1 + 2. The systems were evaluated with individual samples and mixtures of 5 and 10 sera from healthy blood donors and from HIV-1 and/or HIV-2 positive and undetermined persons. It was observed that the utilization of mixtures of 10 sera is not feasible; however, the use of mixtures of 5 affects neither the specificity nor the sensitivity of the systems studied.