Single-point and kinetics of peripheral residual disease by mass spectrometry to predict outcome in patients with high risk smoldering multiple myeloma included in the GEM-CESAR trial.

The value of quantitative immunoprecipitation mass spectrometry (QIP-MS) to identify the M-protein is being investigated in patients with monoclonal gammopathies but no data are yet available in high-risk smoldering myeloma (HRsMM). We have therefore investigated QIP-MS to monitor peripheral residual disease (PRD) in 62 HRsMM patients enrolled in the GEM-CESAR trial. After 24 cycles of maintenance, detecting the M-protein by MS or clonal plasma cells by NGF identified cases with a significantly shorter median PFS (mPFS; MS: not reached vs 1,4 years, p=0.001; NGF: not reached vs 2 years, p=0.0002) but reaching CR+sCR did not discriminate patients with different outcome. With NGF as a reference, the combined results of NGF and MS showed a high negative predictive value (NPV) of MS: 81% overall and 73% at treatment completion. When sequential results were considered, sustained negativity by MS or NGF was associated with a very favorable outcome with a mPFS not yet reached vs 1.66 years and 2.18 years in cases never attaining PRD or minimal residual disease (MRD) negativity, respectively. We can thus conclude that 1) the standard response categories of the IMWG do not seem to be useful for treatment monitoring in HRsMM patients, 2) MS could be used as a non-invasive, clinical valuable tool with the capacity of guiding timely bone marrow evaluations (based on its high NPV with NGF as a reference) and 3) similarly to NGF, sequential results of MS are able identify a subgroup of HRsMM patients with long-term disease control. This study was registered at www.clinicaltrials.gov (ClinicalTrials.gov identifier: NCT02415413).

Mass Spectrometry as Alternative Method to Identify and Monitor Non-Secretory Progressive Disease in Patients with Multiple Myeloma.

INTRODUCTION: After receiving different lines of treatment, multiple myeloma patients tend to present with less secretory and more frequent extramedullary disease. These features make treatment monitoring and follow-up very complex since they have to be based on the use of imaging methods and/or bone marrow aspirations or biopsies. OBJECTIVE: To present the case of a patient with myeloma progressing with non-secretory bone disease and to discuss the potential impact of mass spectrometry as a new highly sensitive method able to identify the monoclonal protein (MP) in the serum of these types of patients. MATERIALS AND METHODS: Informed consent was signed by the patient prior to receiving each line of treatment. The clinical information and images were obtained from anonymized electronic files. The mass spectrometry was performed with the Immunoglobulin Isotypes (GAM) assay for the mass spectrometry EXENT® Analyser Technology from Binding Site, part of Thermofisher. RESULTS: A 73-year-old male with IgG kappa multiple myeloma progressing with a new lytic lesion after receiving 14 cycles of Talquetamab as a third line of therapy who, due to the non-secretory nature of the disease at this point, could not be enrolled in a clinical trial, thus limiting his therapeutic options. The mass spectrometry was able to identify and quantify the presence of the patient's MP when the serum protein electrophoresis and immunofixation were still negative and therefore could have been used to confirm the progression, to permit the inclusion of the patient in a clinical trial and to further monitor the disease response. CONCLUSIONS: The higher sensitivity of the mass spectrometry methods to detect the MP in patients with myeloma and other monoclonal gammopathies translates into better identification of the disease progression, permits the inclusion of more patients in clinical trials and facilitates treatment monitoring.

Amantadine as an Aid to Extubation in Severe Acute Brain Injury: A Case Series.

For a subset of patients with severe acute brain injury (SABI) undergoing invasive mechanical ventilation, the primary barrier to successful extubation is depressed mental status. Amantadine is a neurostimulant that has been demonstrated to increase arousal and improve functional outcomes in patients with SABI. In this case series, we describe 5 patients with SABI and invasive mechanical ventilation who received amantadine as an agent to improve mental status to allow extubation. The primary barrier to extubation for all patients was depressed mental status. Median age was 77 (range 32 to 82). Primary diagnoses were ischemic stroke (n = 1), subdural hemorrhage (n = 2), intracerebral hemorrhage (n = 1), and traumatic brain injury (n = 1). Median Glasgow Coma Score was 7T prior to administration of amantadine and 10T on the day after amantadine was initiated, with improvements in eye-opening and motor response. Four patients displayed improvement in arousal and attention and were successfully extubated 1 to 4 days after initiation of amantadine (median 2 days). The fifth patient only displayed marginal improvement in mental status after starting amantadine, but was ultimately able to be extubated 7 days later. Amantadine may improve the likelihood of or reduce the time to successful extubation in patients with SABI.

Optimizing herbicide selection for pre-emergence control of itchgrass and cypressvine morningglory in sugarcane.

The aim of this study was to assess the efficacy of herbicides in association to control Rottboellia exaltata and Ipomoea quamoclit during pre-emergence while also to evaluate the potential impact on the sugarcane. The experimental design employed a randomized block with seven treatments and four replications. The treatments were: 1 - no herbicide application; 2 - indaziflam + sulfentrazone; 3 - indaziflam + diclosulam; 4 - indaziflam + tebuthiuron; 5 - flumioxazin + diclosulam, 6 - flumioxazin + pyroxasulfone and 7 - clomazone + sulfentrazone. The evaluated parameters were: percentage of weeds control, green coverage percentage (Canopeo® system), weed biomass (g m-2), itchgrass height, and sugarcane tiller. Several herbicide associations have been proven effective alternatives for managing itchgrass and cypressvine morningglory. The most successful treatments for itchgrass control were indaziflam + tebuthiuron (100%) and indaziflam + diclosulam (97%), whereas for cypressvine morningglory, the betters were indaziflam + sulfentrazone (97%), indaziflam + diclosulam (98%), indaziflam + tebuthiuron (97%), flumioxazin + diclosulam (94%), and clomazone + sulfentrazone (96%). All treatments reduced the weed biomass, with indaziflam + tebuthiuron being the safest option for protecting sugarcane.

Phytoremediation Performance with Ornamental Plants in Monocultures and Polycultures Conditions Using Constructed Wetlands Technology.

The assessment of constructed wetlands (CWs) has gained interest in the last 20 years for wastewater treatment in Latin American regions. However, the effects of culture systems with different ornamental species in CWs for phytoremediation are little known. In this study, some chemical parameters such as total suspended solids (TSS), chemical oxygen demand (COD), phosphate (PO4-P), and ammonium (NH4-N) were analyzed in order to prove the removal of pollutants by phytoremediation in CWs. The environmental impact index based on eutrophication reduction (EI-E) was also calculated to estimate the cause-effect relationship using CWs in different culture conditions. C. hybrids and Dieffenbachia seguine were used in monoculture and polyculture (both species mixed) mesocosm CWs. One hundred eighty days of the study showed that CWs with plants in monoculture/polyculture conditions removed significant amounts of organic matter (TSS and COD) (p > 0.05; 40-55% TSS and 80-90% COD). Nitrogen and phosphorous compounds were significantly lower in the monoculture of D. seguine (p < 0.05) than in monocultures of C. hybrids, and polyculture systems. EI-E indicator was inversely proportional to the phosphorous removed, showing a smaller environmental impact with the polyculture systems (0.006 kg PO43- eq removed) than monocultures, identifying the influence of polyculture systems on the potential environmental impacts compared with the phytoremediation function in monocultures (0.011-0.014 kg PO43- eq removed). Future research is required to determine other types of categories of environmental impact index and compare them with other wastewater treatment systems and plants. Phytoremediation with the ornamental plants studied in CWs is a good option for wastewater treatment using a plant-based cleanup technology.

Understanding how environmental degradation, microclimate, and management shape honey production across different spatial scales.

Although the abundance, survival, and pollination performance of honeybees are sensitive to changes in habitat and climate conditions, the processes by which these effects are transmitted to honey production and interact with beekeeping management are not completely understood. Climate change, habitat degradation, and beekeeping management affect honey yields, and may also interact among themselves resulting in indirect effects across spatial scales. We conducted a 2-year, multi-scale study on Chiloe Island (northern Patagonia), where we evaluated the most relevant environmental and management drivers of honey produced by stationary beekeepers. We found that the effects of microclimate, habitat, and management variables changed with the spatial scale. Among the environmental variables, minimum temperature, and cover of the invasive shrub, gorse (Ulex europaeus) had the strongest detrimental impacts on honey production at spatial scales finer than 4 km. Specialized beekeepers who adopted conventional beekeeping and had more mother colonies were more productive. Mean and minimum temperatures interacted with the percentage of mother colonies, urban cover, and beekeeping income. The gorse cover increased by the combination of high temperatures and the expansion of urban lands, while landscape attributes, such as Eucalyptus plantation cover, influenced beekeeping management. Results suggest that higher temperatures change the available forage or cause thermal stress to honeybees, while invasive shrubs are indicators of degraded habitats. Climate change and habitat degradation are two interrelated environmental phenomena whose effects on beekeeping can be mitigated through adaptive management and habitat restoration.

Impacto del uso de plataformas de video llamadas en las preocupaciones con la apariencia física en pacientes con Trastornos Alimentarios y de la población general durante la Pandemia por COVID 19 / Video call platforms impact on physical appearance concerns in patients with Eating Disorders and general population during the COVID 19 Pandemic

Resumen: Objetivo: Explorar el impacto del uso cotidiano de plataformas de videollamadas en las cogniciones, emociones y comportamientos relacionados con la autoimagen en pacientes con Trastornos del Comportamiento Alimentario (TCA) y personas de la población general, durante la pandemia por COVID-19. Métodos: Sesenta y ocho pacientes con TCA en tratamiento y 106 personas de la población general respondieron a un cuestionario diseñado para el estudio a través de Lime Survey; (98.5 y 79.2% respectivamente eran mujeres), con edad promedio de 17.6 (DE:3.47) y 33.5 (DE:9.35) respectivamente. Las pacientes discutieron y explicaron sus respuestas en cinco sesiones de terapia grupal presenciales dirigidas por un psiquiatra. Posteriormente, se realizó un análisis temático reflexivo con un enfoque inductivo para determinar las categorías. Resultados: Los pacientes reportaron una mayor incomodidad frente a la cámara, preocupación con la apariencia física, miedo a la crítica, vergüenza y sentimientos de vulnerabilidad, comparados con las personas de la población general. Predominaron los pensamientos negativos sobre la forma y el tamaño del rostro y otras partes del cuerpo y las conductas de chequeo y/o evitación de la imagen corporal, que interfirieron con la concentración y el rendimiento. Conclusión: además del impacto negativo de la pandemia de COVID-19 en la salud mental, la nueva virtualidad desafía a los clínicos a enfrentar dificultades adicionales con la imagen corporal en pacientes con TCA y alerta a la detección de nuevas preocupaciones dismórficas también en la población general.

Abstract: Objective: To explore the impact of video call platforms on physical appearance concerns (cognitions, emotions and behaviors) in Eating Disorders (ED) patients and in general population, during COVID 19 pandemic. Methods: Sixty-eight patients attending a treatment program for ED, and 106 people from the general population responded to a questionnaire designed for the study through Lime Survey; (98.5 and 79.2% respectively were women), with a mean age of 17.6 (SD:3.47) and 33.5 (SD:9.35) respectively. Patients discussed and explained their answers in five in vivo group therapy sessions directed by a psychiatrist. Then, a reflective thematic analysis with an inductive approach to determine the categories was performed. Results: Patients reported a higher discomfort in front of the camera, preoccupation with physical appearance, fear of criticism, embarrassment, and feelings of vulnerability, compared with general population. Negative thoughts about the shape and size of the face and other body parts predominated, as well as body image checking/avoidance behaviors that interfered with concentration and performance. Conclusion: In addition to the negative impact of the COVID-19 pandemic on mental health, the new virtuality challenges clinicians to face additional body image difficulties in ED patients and alerts on the detection of dysmorphic concerns in the general population as well.

Feasibility and acceptability of comprehensive virtual treatment in eating disorders: perspectives from patients, parents and therapists during the COVID-19 pandemic.

BACKGROUND: Lockdowns and social distancing as a result of the COVID-19 pandemic have brought about the need to continue treatment virtually in patients with Eating Disorders (ED). OBJECTIVE: To evaluate feasibility, acceptability and adherence to virtual treatment in patients, families and therapists. METHODS: Fourteen patients, 10 family members and eight therapists from an intensive outpatient program for ED answered online surveys and a SWOT analysis was performed with the responses. RESULTS: Virtual treatment during lockdown was considered feasible and useful by all respondents. Fear of contagion and the presence of parents in the home were identified as strengths. Parents reported problems with nutritional plan compliance, especially in anorexia patients. Therapists highlighted the importance of methodological adaptations in sessions to improve participation. Adherence to sessions was 100% for family members and 90% for patients. CONCLUSIONS: Adaptation to a virtual program is a valid and useful option during lockdowns. It improves family participation, but does not replace face-to-face treatment.

Selectivity and control of Euphorbia heterophylla in sugarcane by herbicide in post-emergence.

To obtain good control of wild poinsettia (Euphorbia heterophylla) in post-emergence in sugarcane crop, we evaluate the herbicides association on post-emergence of E. heterophylla and the ratoon cane selectivity. The experimental scheme was in randomized blocks with 6 treatments and 4 replications. The treatments were: control; ametryn + mesotrione + sulfentrazone (1,500 + 144 + 800 g i.a ha-1); ametryn + mesotrione + diclosulan (1,500 + 144 + 200 g i.a ha-1); ametryn + mesotrione (2,500 + 144 g i.a ha-1: Highest dose); ametryn + mesotrione (2,000 + 144 g i.a ha-1: Lowest dose) and ametryn + mesotrione + diuron (1,000 + 144 + 1,250 g i.a ha-1). The percentage of control, dry mass, height and percentage of germination of E. heterophylla and injury level, yield and technological quality of sugarcane were evaluated. The best control of E. heterophylla was: ametryn + mesotrione +sulfentrazone; ametryn + mesotrione + diclosulan and ametryn + mesotrione (Lowest dose). As for the ratoon cane selectivity the best yield was achieved with the association ametryn + mesotrione +diclosulan. An appropriate association of herbicide molecules provides successful control of E. heterophylla, especially the association of sulfentrazone or diclosulan together with ametryn and mesotrione.

Visual impairment in mucopolysaccharidosis VI.

Mucopolysaccharidosis (MPS) VI is a rare genetic disease characterized by deficient activity of N-acetylgalactosamine 4-sulfatase, leading to the systemic deposition of glycosaminoglycans. Ocular involvement is classically characterized by progressive corneal clouding, ocular hypertension (OHT), and optic neuropathy. Although corneal clouding can be solved with penetrating keratoplasty (PK), visual impairment usually remains, being frequently attributed to glaucoma. The purpose of this study was to retrospectively describe a series of MPS VI patients with optic neuropathy in order to deepen the knowledge regarding the causes of severe visual impairment among these patients. We present five genetically confirmed clinical cases of MPS VI, treated with enzymatic replacement therapy, and with regular systemic and ophthalmologic follow-up. Corneal clouding was a common early presenting feature, leading to PK in four patients. During their follow-up, all patients developed very low visual acuities regardless of corneal grafts outcomes and controlled intraocular pressure (IOP). Furthermore, all patients exhibited optic atrophy and imagiological evidence of significant subarachnoid space enlargement and consequent optic nerve thickness reduction, suggesting compression of the optic nerve in a retro-ocular location as the cause of optic neuropathy. Although optic neuropathy in MPS VI is commonly attributed to glaucoma due to OHT, by describing a series of five MPS VI patients, we provided evidence that, differently from glaucoma, compression of optic nerve in a retro-ocular location is crucial for the development of optic neuropathy, at least in some cases. We propose the denomination of posterior glaucoma and suggest it as an important cause of optic neuropathy, leading to severe visual impairment and blindness among these patients.

Fertilizer source and application method influence sugarcane production and nutritional status.

Introduction: The contrasting weather conditions throughout the sugarcane harvest period in south-central Brazil (April to November) influence fertilization management in sugarcane ratoon. Methods: Through field studies carried out over two cropping seasons, we aimed to compare the performance of sugarcane at sites harvested in the early and late periods of the harvest season as a function of fertilizer sources associated with application methods. The design used in each site was a randomized block in a 2 x 3 factorial scheme; the first factor consisted of fertilizer sources (solid and liquid), and the second factor consisted of application methods (above the straw, under the straw, and incorporated into the middle of the sugarcane row). Results: The fertilizer source and application method interacted at the site harvested in the early period of the sugarcane harvest season. Overall, the highest sugarcane stalk and sugar yields at this site were obtained with the incorporated application applying liquid fertilizer and under straw applying solid fertilizer, with increments of up to 33%. For the site harvested in the late period of the sugarcane harvest season, the liquid fertilizer promoted a 25% higher sugarcane stalk yield compared to the solid fertilizer in the crop season with low rainfall in the spring, while in the crop season with normal rainfall, there were no differences between treatments. Discussion: This demonstrates the importance of defining fertilization management in sugarcane as a function of harvest time, thereby promoting greater sustainability in the production system.

Integrating Depression and Alcohol Use Care Into Primary Care in Low- and Middle-Income Countries: A Meta-Analysis.

OBJECTIVE: Evaluation of the effectiveness of integration of depression and alcohol use disorder care into primary health care in low- and middle-income countries (LMICs) is limited. The authors aimed to quantify the effectiveness of integrating mental health care into primary care by examining depression and alcohol use disorder outcomes. The study updates a previous systematic review summarizing research on care integration in LMICs. METHODS: Following PRISMA guidelines, the authors included studies from the previous review and studies published from 2017 to 2020 that included adults with alcohol use disorder or depression. Studies were evaluated for type of integration model with the typology developed previously. A meta-analysis using a random-effects model to assess effectiveness of integrated interventions was conducted. Meta-regression analyses to examine the impact of study characteristics on depression and alcohol use disorder outcomes were conducted. RESULTS: In total, 49 new articles were identified, and 74 articles from the previous and current studies met inclusion criteria for the meta-analysis. Overall random effect sizes were 0.28 (95% CI=0.22-0.35) and 0.17 (95% CI=0.11-0.24) for studies targeting care integration for depression or for alcohol use disorder, respectively, into primary care in LMICs. High heterogeneity within and among studies was observed. No significant association was found between country income level and depression and alcohol use outcomes. However, differences in effect sizes between types of integration model were statistically significant (p<0.001). CONCLUSIONS: Integration of mental health care into primary health care in LMICs was found to improve depression and alcohol use disorder outcomes. This evidence should be considered when designing interventions to improve mental health screening and treatment in LMICs.

Covariation of taxonomic and functional facets of ß-diversity in Chilean freshwater fish assemblages: Implications for current and future processes of biotic homogenization.

The biodiversity of assemblages that experience the introduction and extinction of species may lead to responses in two important facets: The taxonomic and functional diversity. The way in which these facets are associated may reveal important implications and consequences for the conservation of those assemblages. Considering the critical situation of freshwater fishes in continental Chile (30° - 56° S), we analyzed how the taxonomic (TDß) and functional (FDß) facets of ß-diversity, and their components of turnover and nestedness, are associated. We evaluated changes in ß-diversity (ΔTDß and ΔFDß), turnover (ΔTDtur and ΔFDtur), and nestedness (ΔTDnes and ΔFDnes) in 20 fish assemblages from their historical (pre-European) to current composition. We also simulated future trends of these changes, assuming that native species with conservation issues would become extinct. Our results show that the fish assemblages studied are in a process of loss of ß-diversity, both in taxonomic and functional facets (ΔTDß = -3.9%; ΔFDß = -30.4%); also, that these facets are positively correlated in the assemblages studied (r = 0.617; P < 0.05). Both components showed by loss in nestedness (ΔTDnes = -36.9%; ΔFDnes = -60.9%) but gain in turnover (ΔTDtur = 9.2%; ΔFDtur = 12.3%). The functional ß-diversity decreased more than the taxonomic (ΔFDß > ΔTDß), which was caused chiefly by six exotic species of Salmonidae, whose geographical spread was wider and that at the same time shared several morpho-functional traits. Our forecasts, assuming an intensification in the extinction of Endangered and Vulnerable native species, indicate that the process of homogenization will continue, though at a lower rate. Our study shows that the freshwater ichthyofauna of continental Chile is undergoing biotic homogenization, and that this process involves the facets of taxonomic and functional ß-diversity, which are show high correlation between historical and current compositions. Both facets show that process is influenced by nestedness, and while turnover contributes to differentiation (both taxonomic and functional), its importance is overshadowed by nestedness.

Leveraging Telehealth for the Management of Breast Cancer: A Systematic Review.

BACKGROUND: Breast cancer affects 2.3 million women and kills 685,000 globally, making it the most prevalent cancer. The telemedicine modality has been used to treat the symptoms associated with breast cancer recovery. OBJECTIVES: To analyze the effectiveness of telemedicine to help women recover from the treatment-associated effects and promote overall recovery from breast cancer. METHODS: Four databases were queried for published literature from the last 10 years. The systematic literature review was conducted in accordance with the Kruse Protocol and reported in accordance with PRISMA 2020. RESULTS: Five interventions were identified in the literature, with the most dominant being eHealth and mHealth. The other interventions were telephone, video teleconference, and a combination of eHealth and mHealth. There were positive effects of these telemedicine interventions in 88% of the studies analyzed. Telemedicine is shown to positively affect physical and mental health, sleep outcomes, quality of life, and body image. The largest barriers to the adoption of telemedicine interventions are training, cost, workflow, time of providers, and low reimbursement. CONCLUSION: Telemedicine offers promise to both providers and breast cancer survivors to improve the physical and mental health detriments of both cancer and its associated treatments. It also helps women develop healthy habits to reduce the risk of reoccurrence.

Perceived access to general and mental healthcare in primary care in Colombia during COVID-19: A cross-sectional study.

Introduction: The COVID-19 pandemic has had an impact both in general and mental healthcare, challenged the health systems worldwide, and affected their capacity to deliver essential health services. We aimed to describe perceived changes in ease of access to general and mental healthcare among patients with a diagnosis of depression and/or unhealthy alcohol use in Colombia. Methods: This study is embedded in the DIADA project, a multicenter implementation research study aimed at evaluating the integration of mental healthcare in primary care in Colombia. Between November 2020 and August 2021, we conducted a COVID-19 pandemic impact assessment in a cohort of participants with newly diagnosed depression and/or unhealthy alcohol use part of DIADA project. We assessed the ease of access and factors related to perceived ease of access to general or mental healthcare, during the COVID-19 pandemic. Results: 836 participants completed the COVID-19 pandemic impact assessment. About 30% of participants considered their mental health to be worse during the pandemic and 84.3% perceived access to general healthcare to be worse during the pandemic. Most of participants (85.8%) were unable to assess access to mental health services, but a significant proportion considered it to be worse. Experiencing worse ease of access to general healthcare was more frequent among women, patients with diagnosis of depression, and patients with comorbidities. Experiencing worse ease of access to mental healthcare was more frequent among patients aged between 30 and 49.9 years, from socioeconomic status between 4 and 6, affiliated to the contributive social security regime, attending urban study sites, and those who perceived their mental health was worse during the pandemic. Discussion: Despite the overall perception of worse mental health during the pandemic, the use of mental healthcare was low compared to general healthcare. Ease of access was perceived to be worse compared to pre-pandemic. Ease of access and access were affected by geographical study site, socioeconomic status, age and gender. Our findings highlight the need for improved communication between patients and institutions, tailored strategies to adapt the healthcare provision to patients' characteristics, and continued efforts to strengthen the role of mental healthcare provision in primary care.

Comparison of the First and Second Wave of Infections by SARS-CoV-2: A Retrospective and Longitudinal Study From a Primary Health Care Center in Santiago of Chile.

The current COVID-19 pandemic is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Many countries have reported the experience of at least two contagion waves, describing associated mortality rates and population behavior. The analysis of the effect of this pandemic in different localities can provide valuable information on the key factors to consider in the face of future massive infectious diseases. This work describes the first retrospective and comparative study about behavior during the first and second waves of the COVID-19 pandemic in Chile from a primary Healthcare Center. From 19,313 real-time quantitative PCR (RT-qPCR) tests assessed, the selected 1,694 positive diagnostics showed a decrease in mortality rate in the second wave (0.6%) compared with the first (4.6%). In addition, we observed that infections in the second wave were mainly in young patients with reduced comorbidities. The population with a complete vaccination schedule shows a decrease in the duration of symptoms related to the disease, and patients with more comorbidities tend to develop severe illness. This report provides evidence to partially understand the behavior and critical factors in the severity of the COVID-19 pandemic in the population of Santiago of Chile.

Scaling Up Science-Based Care for Depression and Unhealthy Alcohol Use in Colombia: An Implementation Science Project.

BACKGROUND: Mental disorders are a major cause of the global burden of disease and significantly contribute to disability and death. This challenge is particularly evident in low- and middle-income countries (LMICs), where >85% of the world's population live. Latin America is one region comprising LMICs where the burden of mental disorders is high and the availability of mental health services is low. This is particularly evident in Colombia, a country with a long-standing history of violence and associated mental health problems. METHODS: This article describes the design of a multisite implementation science project, "Scaling Up Science-Based Mental Health Interventions in Latin America" (also known as the DIADA project), that is being conducted in six primary care systems in Colombia. This project, funded via a cooperative agreement from the National Institute of Mental Health, seeks to implement and assess the impact of a new model for promoting widespread access to mental health care for depression and unhealthy alcohol use within primary care settings and building an infrastructure to support research capacity and sustainability of the new service delivery model in Colombia. This care model centrally harnesses mobile health technology to increase the reach of science-based mental health care for depression and unhealthy alcohol use. RESULTS: This initiative offers great promise to increase capacity for providing and sustaining evidence-based treatment for depression and unhealthy alcohol use in Colombia. NEXT STEPS: This project may inform models of care that can extend to other regions of Latin America or other LMICs.

Feasibility and Acceptability of Comprehensive Virtual Treatment in Eating Disorders: Perspectives from Patients, Parents and Therapists During the COVID-19 Pandemic. / Viabilidad y Aceptabilidad del Tratamiento Integral Virtual en Trastornos Alimentarios: Perspectiva de Pacientes, Padres y Terapeutas Durante la Pandemia por COVID-19.

BACKGROUND: Lockdowns and social distancing as a result of the COVID-19 pandemic have brought about the need to continue treatment virtually in patients with Eating Disorders (ED). OBJECTIVE: To evaluate feasibility, acceptability and adherence to virtual treatment in patients, families and therapists. METHODS: Fourteen patients, 10 family members and eight therapists from an intensive outpatient program for ED answered online surveys and a SWOT analysis was performed with the responses. RESULTS: Virtual treatment during lockdown was considered feasible and useful by all respondents. Fear of contagion and the presence of parents in the home were identified as strengths. Parents reported problems with nutritional plan compliance, especially in anorexia patients. Therapists highlighted the importance of methodological adaptations in sessions to improve participation. Adherence to sessions was 100% for family members and 90% for patients. CONCLUSIONS: Adaptation to a virtual program is a valid and useful option during lockdowns. It improves family participation, but does not replace face-to-face treatment.

Access barriers, self-recognition, and recognition of depression and unhealthy alcohol use: A qualitative study.

INTRODUCTION: Access to healthcare services involves a complex dynamic, where mental health conditions are especially disadvantaged, due to multiple factors related to the context and the involved stakeholders. However, a characterisation of this phenomenon has not been carried out in Colombia, and this motivates the present study. OBJECTIVES: The objective of this study was to explore the causes that affect access to health services for depression and unhealthy alcohol use in Colombia, according to various stakeholders involved in the care process. METHODS: In-depth interviews and focus groups were conducted with health professionals, administrative professionals, users, and representatives of community health organisations in five primary and secondary-level institutions in three regions of Colombia. Subsequently, to describe access to healthcare for depression and unhealthy alcohol use, excerpts from the interviews and focus groups were coded through content analysis, expert consensus, and grounded theory. Five categories of analysis were created: education and knowledge of the health condition, stigma, lack of training of health professionals, culture, and structure or organisational factors. RESULTS: We characterised the barriers to a lack of illness recognition that affected access to care for depression or unhealthy alcohol use according to users, healthcare professionals and administrative staff from five primary and secondary care centres in Colombia. The groups identified that lack of recognition of depression was related to low education and knowledge about this condition within the population, stigma, and lack of training of health professionals, as well as to culture. For unhealthy alcohol use, the participants identified that low education and knowledge about this condition, lack of training of healthcare professionals, and culture affected its recognition, and therefore, healthcare access. Neither structural nor organisational factors seemed to play a role in the recognition or self-recognition of these conditions. CONCLUSIONS: This study provides essential information for the search for factors that undermine access to mental health in the Colombian context. Likewise, it promotes the generation of hypotheses that can lead to the development and implementation of tools to improve care in the field of mental illness.