Thyroiditis and COVID-19: focus on pediatric age. A narrative review.

PURPOSE: In light of the growing concern over the possible link between SARS-CoV2 infection and autoimmune diseases, we conducted a review to investigate the impact of the pandemic outbreak on thyroid diseases. METHODS: We carried out a narrative review of all pediatric cases described in the literature, mainly focusing on the possible association of COVID-19 with the incidence of autoimmune and post-infective thyroid diseases (namely Hashimoto's Thyroiditis (HT), Grave's Disease (GD) and Sub-Acute Thyroiditis (SAT)). We also felt it was necessary to provide a brief review of Non-thyroidal Illness Syndrome (NTIS) and Multisystem Inflammatory Syndrome in Children (MIS-C) because of their overlap with thyroiditis. RESULTS: There is currently no conclusive evidence linking SARS-CoV-2 infection with an increased incidence of autoimmune thyroiditis (AT) in pediatric age. However, SAT may be a mild complication of SARS-CoV-2 infection, as is the case with other viral infections. SAT typically resolves on its own and does not require treatment. NTIS may be associated with inflammatory complications, such as MIS-C, and admission to intensive care. It may also be considered a prognostic risk factor for severe disease. The hypothesized pathogenetic mechanisms of thyroid damage in COVID-19 include direct damage due to the significant expression of angiotensin-converting enzyme 2 (ACE2) in the thyroid gland, which is a ligand for the virus, and indirect damage due to immune dysregulation, such as the overproduction of IL-6, which is thought to be part of the pathogenesis of thyroiditis. CONCLUSION: However, due to the limited evidence available, further prospective longitudinal studies are required to clarify the relationship between COVID-19 and thyroid disease in children and adolescents, as well as to investigate any potential long-term consequences.

Examining the Role of Cultural and Family Factors in Substance Use Risk Among Indian American Youth.

INTRODUCTION: Although Indian Americans constitute the second-largest immigrant group in the United States, there is a paucity of information about Indian American youth, particularly with respect to substance use risk. We examined the relationship of social factors to permissive substance use beliefs (a proxy for substance use risk since they can lead to adulthood substance use and misuse) and family functioning. METHODS: The study used structural equation modeling to examine the prevalence of permissive substance use beliefs in a sample of Indian American youth ages 12-17 (N = 223) and examined the degree to which discrimination, bicultural identity integration, and endorsement of the model minority stereotype were associated with permissive substance use beliefs. RESULTS: Findings suggest that bicultural identity integration (B = 0.267 [SE = 0.112], p = 0.01) and discrimination (B = 0.294 [SE = 0.087], p = 0.001) are positively associated with permissive substance use beliefs. Bicultural identity integration (B = 0.415 [SE = 0.090], p = 0.0001) was positively associated with family support (B= -0.329 [SE = 0.108], p = 0.002) which, in turn, was associated with less permissive substance use beliefs. In contrast, endorsement of the model minority stereotype (B = 0.351 [SE = 0.090], p = 0.001) was positively associated with family closeness (B = 0.232 [SE = 0.927], p = 0.01) which, in turn, was associated with family support and then with less permissive substance use beliefs. CONCLUSIONS: Discrimination and bicultural identity integration emerged as key constructs related to substance use risk among Indian American youth. These youth could benefit from culturally appropriate prevention programming that addresses the negative impact of discrimination and its effect on permissive substance use beliefs and highlights protective factors.

Tall stature and gigantism in transition age: clinical and genetic aspects-a literature review and recommendations.

PURPOSE: Tall stature is defined as height greater than the threshold of more than 2 standard deviations above the average population height for age, sex, and ethnicity. Many studies have described the main aspects of this condition during puberty, but an analysis of the characteristics that the physician should consider in the differential diagnosis of gigantism-tall stature secondary to a pituitary tumour-during the transition age (15-25 years) is still lacking. METHODS: A comprehensive search of English-language original articles was conducted in the MEDLINE database (December 2021-March 2022). We selected all studies regarding epidemiology, genetic aspects, and the diagnosis of tall stature and gigantism during the transition age. RESULTS: Generally, referrals for tall stature are not as frequent as expected because most cases are familial and are usually unreported by parents and patients to endocrinologists. For this reason, lacking such experience of tall stature, familiarity with many rarer overgrowth syndromes is essential. In the transition age, it is important but challenging to distinguish adolescents with high constitutional stature from those with gigantism. Pituitary gigantism is a rare disease in the transition age, but its systemic complications are very relevant for future health. Endocrine evaluation is crucial for identifying conditions that require hormonal treatment so that they can be treated early to improve the quality of life and prevent comorbidities of individual patient in this age range. CONCLUSION: The aim of our review is to provide a practical clinical approach to recognise adolescents, potentially affected by gigantism, as early as possible.

Strong winds as driver of surf zooplankton abundance and composition in a temperate sandy beach.

This study explores the effect of different wind events (direction and duration) on the surf zone zooplankton community in a temperate sandy beach. Samplings were realized on the surf zone of Pehuen Co sandy beach during 17 wind events from May 17th, 2017, to July 19th, 2019. Biological samples were taken before and after the events. The identification of the events was realized using recorded high-frequency wind speed data. General Linear Model (LM) and Generalized linear models (GLM) were employed to compare physical and biological variables. We observed that the wind direction unequally altered the ecosystem along with its duration, modifying the composition and abundance of zooplankton communities. Short-duration wind events were associated with an increment in the zooplankton abundances, being Acartia tonsa and Paracalanus parvus dominant. Within the short-duration cases, winds from the W sector were identified with the inner continental shelf species' presence, such as Ctenocalanus vanus and Euterpina acutifrons, and to a lesser extent, Calanoides carinatus, and Labidocera fluviatilis, together with surf zone copepods. Long-duration cases were associated with a significant decrease in the zooplankton abundance. Within this group, SE-SW wind events were identified with adventitious fraction taxa. Considering that the occurrence of extreme events is growing because of climate change, affecting the frequency and intensity of storm surges, the knowledge of the responses of biological communities to these events is necessary. This work provides quantitative evidence on a short-time scale of the implications of the physical-biological interaction during different strong wind cases in surf zone waters of sandy beaches.

Interannual changes in winter-spring zooplankton estuarine community forced by hydroclimatic variability - With special reference to bioindicator species Eurytemora americana.

Climatic variability and anthropogenic pressures impact the structure and dynamics of pelagic ecosystems and copepods are good indicators of such changes. This investigation aims to explore the interannual pattern of the mesozooplankton community, in relation to environmental variables in the Bahía Blanca Estuary during winter-spring from last two decades focusing on the dominant species Eurytemora americana. Main changes recorded include increased temperature, alteration of the nutrient balance, a decrease in chlorophyll-a, modifications in the abundance-structure of the phytoplankton assemblages, and changes in the abundance-structure of the mesozooplankton community. A significant decrease was observed in species richness of the mesozooplankton over time. Alterations in abundance and reproductive traits of E. americana, were also found. The population of E. americana dropped from mean relative abundance of 47% in first years to 20-12% in lasts one, accompanied with an increase of copepod species characterized by higher trophic plasticity in eutrophic conditions, like Acartia tonsa and Euterpina acutifrons.

[RS3PE syndrome: An update on its treatment using the presentation of a case]. / El síndrome RS3PE: actualización de su tratamiento a propósito de un caso.

The present study was undertaken in order to try to clarify certain aspects of RS3PE syndrome, for which there is no unanimity of opinion in the current literature. An attempt will be made to clarify the best and most suitable drug for treatment, and the dosage duration. In order to do this, a literature search was performed, and a review is presented of the 108 cases collected. In 95% cases glucocorticoids were the most used, with prednisone in being used in 68.5% of cases. Although there is no unanimity criteria regarding the dosage and duration, 73.8% cases were treated with a prednisone dose from 15 to 20 mg/day (median 18.2 mg/day, SD 8.9). Two-thirds (66.1%) of cases were treated for 3 to 6 months (median 5.3 months, SD 3.8). A case is presented that serves as a common thread of these observations.

Barriers to implementing evidence-based practices in addiction treatment programs: comparing staff reports on Motivational Interviewing, Adolescent Community Reinforcement Approach, Assertive Community Treatment, and Cognitive-behavioral Therapy.

PURPOSE: This qualitative study explored barriers to implementing evidence-based practices (EBPs) in community-based addiction treatment organizations (CBOs) by comparing staff descriptions of barriers for four EBPs: Motivational Interviewing (MI), Adolescent Community Reinforcement Approach (A-CRA), Assertive Community Treatment (ACT), and Cognitive-behavioral Therapy (CBT). METHODS: The CBOs received CSAT/SAMHSA funding from 2003 to 2008 to deliver services using EBPs. Phone interview responses from 172 CBO staff directly involved in EBP implementation were analyzed using content analysis, a method for making inferences and developing themes from the systematic review of participant narratives (Berelson, 1952). RESULTS: Staff described different types of barriers to implementing each EBP. For MI, the majority of barriers involved staff resistance or organizational setting. For A-CRA, the majority of barriers involved specific characteristics of the EBP or client resistance. For CBT, the majority of barriers were associated with client resistance, and for ACT, the majority of barriers were associated with resources. DISCUSSION: EBP designers, policy makers who support EBP dissemination and funders should include explicit strategies to address such barriers. Addiction programs proposing to use specific EBPs must consider whether their programs have the organizational capacity and community capacity to meet the demands of the EBP selected.

Legionnaires' disease caused by Legionella longbeachae and Legionella pneumophila: comparison of clinical features, host-related risk factors, and outcomes.

Legionnaires' disease remains an important cause of mortality and morbidity worldwide. Disease caused by Legionella pneumophila has been extensively studied, and its clinical characteristics have been well described. There is, however, little information on disease caused by Legionella longbeachae, despite its importance in some countries. We undertook a retrospective review of culture-positive cases of Legionnaires' disease in the Canterbury region of New Zealand over 10 years, in order to compare the clinical features and outcomes of Legionnaires' disease caused by these two species.

Racial and ethnic differences in drug treatment entry of injection drug users in Massachusetts.

This article examines patterns of drug treatment entry among 28,000 adult injection drug users (IDUs), with special attention to racial and ethnic differences. The data analyzed originates from a statewide drug-treatment database covering four years. Through the use of logistic regression analysis, the study identified significant population differences between those who used detoxification only, those who used residential treatment and those who used methadone maintenance. Latino IDUs were approximately a third less likely than Caucasian IDUs to enter residential treatment and African American IDUs were half as likely as Caucasian IDUs to enter methadone maintenance treatment. This article discusses specific programmatic and research implications including the need to determine whether differential entry rates are due to access, client awareness, cultural, referral or other factors.

Social workers and subbstance-abusing clients: caseload composition and competency self-ratings.

Past research and reports from the field have described social workers as having a host of negative responses to alcohol- and drug-abusing clients. Some found that substance abuse training increased social workers' sense of security and legitimacy in the therapeutic role with such clients. We report on 23 master's level social workers (MSWs) who completed an intensive 9-month substance abuse training program (trainees) and 22 MSW comparison subjects (comparisons). Both trainees and comparisons completed caseload forms identifying their clients by diagnosis and self-rated their competence to assess and treat each client. We predicted that workers trained in substance abuse, when compared with workers who lacked such intensive training, would (a) assess and treat more substance-abusing clients, (b) work with more complex substance-abusing clients (i.e., dually diagnosed clients), and (c) perceive themselves to be more competent to assess and treat substance-abusing clients. No significant differences were found between trainees and comparisons on relevant background variables. Using the t-test statistic to compare groups, we found that social workers trained in substance abuse had more substance abuse cases, with and without additional diagnoses, and rated themselves higher on two of six competency measures: in intervening with clients when all diagnoses were combined and in intervening when substance abuse only diagnoses were combined. This study takes the work a step further in demonstrating how social workers translate substance abuse training into practice. However, findings must be interpreted cautiously since training participants were not assigned randomly and selection bias may have been operating. The study is relevant for other health, mental health, and human service professionals for whom negative attitudes and behavior toward substance-abusing clients may be influenced by education and training.

The therapeutic attitudes and behavior of social work clinicians with and without substance abuse training.

This study examines the influence of substance abuse training on social workers in nonaddiction treatment settings. Eighty-one Masters level social workers who completed a 9-month training program were compared with a matched sample of 78 Masters level social workers who did not enroll, with supervisors as collateral informants. Subjects and supervisors were blind to the purpose of the study. Measures included behavior, clinical skills, and self-rated attitudes. After training, trainees were significantly more likely than comparisons to 1) work with substance-abusing clients, 2) have "substance abuse"-related roles, 3) seek jobs that increased their opportunities to work with substance-abusing clients, 4) assess and intervene with substance abuse, and 5) obtain high ratings of optimism, confidence, and competence.

Social workers employed in substance abuse treatment agencies: a training needs assessment.

This article describes the results of an assessment of the substance abuse treatment training needs of social workers working in randomly selected substance abuse treatment facilities in New England. This assessment revealed that clinical supervision related to substance abuse treatment had not been available to a significant percentage of the respondents throughout their careers. Despite limited previous training experience and considerable barriers to current training, social workers surveyed in this study reported significantly higher levels of knowledge and skill than other substance abuse treatment providers in 10 of 12 substance abuse treatment areas investigated. Despite these high levels of knowledge and skill, respondents reported considerable need for and interest in additional substance abuse treatment training. This study identified the areas of assessment, advanced clinical techniques, and dual diagnosis as priorities for future training among social workers working in substance abuse treatment facilities.

Interdisciplinary teams in health care and human services settings: are they effective?

Empirical evidence for the efficacy of interdisciplinary teams is essential in the current context of managed care. Because careful assessment of the interdisciplinary team has important implications for patients and health care professionals, as well as employers, the authors read over 2,200 abstracts and analyzed 224 articles from four databases in eight health-related fields. Articles were grouped by the type of analysis engaged in by their authors (descriptive, process-focused, empirical, or outcome), by methodology (none, general research, or quantitative), and by domains of interest (patient care, personnel, or management). Findings indicate significant weaknesses in terminology and research content. Directions for future research that would help ascertain the contribution of the interdisciplinary team are outlined.

African-American injection drug users: association between pre-treatment services and entry into and completion of detoxification.

Research suggests that African-American injection drug users, when compared with other ethnic and racial groups of injection drug users, are more likely to have no history of substance abuse treatment. The project evaluated was designed to attract African-American injection drug users to treatment by providing comprehensive pre-treatment services including street outreach, drop-in center services, case management, and motivational counseling. The overall program goal was to facilitate clients' acceptance of referral to treatment and readiness to utilize treatment. The evaluation described here examines whether, for this African-American population of hard-core drug users, utilization of pre-treatment services improved the intermediary treatment outcomes of entry into and completion of detoxification. Findings showed that high utilization of drop-in center services increased the frequency of entrance into detoxification programs. Entrance into detoxification has been shown to be significantly correlated with (a) entrance into further treatment, (b) reduced HIV/AIDS risk, and (c) successful linkage with health care and social services. Contrary to expectations, high utilization of pre-treatment services was not significantly correlated to increased completion of detoxification.

Coping methods and reasons for not drinking.

Methods for coping with stress and reasons for not drinking were examined among abstinent alcoholics to determine whether change occurred with length of sobriety. Results showed that 1) alcoholics with briefer abstinence relied more heavily on coping methods, 2) alcoholics relied less on negative than positive coping methods regardless of length of sobriety, and 3) the number and types of reasons for not drinking did not vary with length of sobriety, rather, several positive reasons for not drinking continued as motivators. Concerning coping methods, the authors speculate that as alcoholics remain sober longer, coping methods become less important or automatic and less conscious.

Evaluating outcomes in a substance abuse training program for Southeast Asian human service workers: problems in measuring change cross-culturally.

The following article describes the evaluation challenges faced in a cross-cultural substance abuse training program. Non-Southeast Asian instructors designed and taught courses for Cambodian and Vietnamese human service workers over a two-year period. Although cultural considerations were a central focus in the design of the program, instructors underestimated the difficulty of modifying standard questionnaires for use with Southeast Asian participants. As a consequence, the formal evaluation process had limited benefit but several insights were gleaned through alternative evaluation methods.

Mixed psychosocial outcomes of sisters from families with alcoholic parents.

To examine intrafamilial differences in adulthood among children of alcoholic parents, 14 women with alcoholic parents and their sisters were assessed for this exploratory study. Reported here is the subset of eight "mixed" sister pairs, one with an impaired adult outcome and the other with a well-adjusted adult outcome. Subjects who scored significantly worse than community norms on depressed mood or social supports or who had a psychiatric diagnosis including substance abuse were categorized as impaired, while the remaining women were categorized as well-adjusted. Both qualitative and quantitative data were collected using a questionnaire and a structured interview. Results showed similarities between the impaired and well-adjusted sisters on individual characteristics, with few differences on characteristics of the parental alcoholism. The most marked differences showed the impaired sisters to score worse than their well-adjusted sisters on characteristics of the home environment and social supports. The impaired women were also more likely to have been physically abused in childhood and to rate the effect of having an alcoholic parent as more negative than the well-adjusted women. Unanticipated findings relating to incest, talents, denial, and racial differences, and their implications for clinicians and researchers, are discussed.

Parental alcoholism and other family disruptions: adult outcomes among sisters.

Adult outcomes were investigated in 14 pairs of African-American and white daughters of alcoholic parents. On the basis of four outcome factors, subjects were divided into three sister-pair categories: well-adjusted, impaired, and mixed. Interviews and standardized questionnaires showed that family-of-origin variables contributing to the impaired adult outcomes included parental psychiatric problems and childhood abuse or neglect.

Enhancement of cell interactions with collagen/glycosaminoglycan matrices by RGD derivatization.

The interaction of three cell types important to the wound repair process with collagen/glycosaminoglycan (GAG) dermal regeneration matrices covalently modified with an Arg-Gly-Asp (RGD)-containing peptide was characterized. Function-blocking monoclonal antibodies directed against various integrin subunits were used to demonstrate that human fibroblasts attached to the unmodified matrix through the integrin, alpha2beta1. Human endothelial cells and human keratinocytes, however, attached minimally to the unmodified matrix. After modification of the collagen/GAG matrix with RGD-containing peptide, endothelial cells and keratinocytes attached and spread well on the matrix. This attachment was RGD dependent as evidenced by essentially complete inhibition with competing soluble peptide. In terms of overall cell number, fibroblast cell attachment remained unchanged on the RGD peptide-modified matrix compared to the unmodified material. Antibody and peptide inhibition studies demonstrate, however, that attachment to the modified matrix was mediated by both alpha2beta1 and RGD-binding integrins. We have successfully introduced a specific RGD receptor-mediated attachment site on collagen/GAG dermal regeneration matrices, resulting in enhanced cell interaction of important wound healing cell types. This modification could have important implications for the performance of these matrices in promoting dermal regeneration.

Mounting a community-based alcohol and drug abuse prevention effort in a multicultural urban setting: Challenges and lessons learned.

This article is designed to help planners and community groups anticipate challenges in implementing community based prevention programs in multicultural urban environments. Empowerment and public health goals are described as essential elements. Methods are recommended for capacity-building with inexperienced participants and balancing long and short term goals in embattled communities.