Correction: Computer-Facilitated Screening and Brief Intervention for Alcohol Use Risk in Adolescent Patients of Pediatric Primary Care Offices: Protocol for a Cluster Randomized Controlled Trial.

[This corrects the article DOI: 10.2196/55039.].

Computer-Facilitated Screening and Brief Intervention for Alcohol Use Risk in Adolescent Patients of Pediatric Primary Care Offices: Protocol for a Cluster Randomized Controlled Trial.

BACKGROUND: Alcohol and other substance use disorders usually begin with substance use in adolescence. Pediatric primary care offices, where most adolescents receive health care, are a promising venue for early identification of substance use and for brief intervention to prevent associated problems and the development of substance use disorder. OBJECTIVE: This study tests the effects of a computer-facilitated screening and brief intervention (cSBI) system (the CRAFFT [Car, Relax, Alone, Forget, Family/Friends, Trouble] Interactive System [CRAFFT-IS]) on heavy episodic drinking, riding with a driver who is substance impaired, or driving while substance impaired among adolescents aged 14 to 17 years presenting for a well visit at pediatric primary care practices. METHODS: We are conducting a cluster randomized controlled trial of the CRAFFT-IS versus usual care and recruiting up to 40 primary care clinicians at up to 20 pediatric primary care practices within the American Academy of Pediatrics (AAP) Pediatric Research in Office Settings network. Clinicians are randomized 1:1 within each practice to implement the CRAFFT-IS or usual care with a target sample size of 1300 adolescent patients aged 14 to 17 years. At study start, intervention clinicians complete web-based modules, trainer-led live sessions, and mock sessions to establish baseline competency with intervention counseling. Adolescents receive mailed recruitment materials that invite adolescents to complete an eligibility survey. Eligible and interested adolescents provide informed assent (parental permission requirement has been waived). Before their visit, enrolled adolescents seeing intervention clinicians complete a self-administered web-based CRAFFT screening questionnaire and view brief psychoeducational content illustrating substance use-associated health risks. During the visit, intervention clinicians access a computerized summary of the patient's screening results and a tailored counseling script to deliver a motivational interviewing-based brief intervention. All participants complete previsit, postvisit, and 12-month follow-up study assessments. Primary outcomes include past 90-day heavy episodic drinking and riding with a driver who is substance impaired at 3-, 6-, 9-, and 12-month follow-ups. Multiple logistic regression modeling with generalized estimating equations and mixed effects modeling will be used in outcomes analyses. Exploratory aims include examining other substance use outcomes (eg, cannabis and nicotine vaping), potential mediators of intervention effect (eg, self-efficacy not to drink), and effect moderation by baseline risk level and sociodemographic characteristics. RESULTS: The AAP Institutional Review Board approved this study. The first practice and clinicians were enrolled in August 2022; as of July 2023, a total of 6 practices (23 clinicians) had enrolled. Recruitment is expected to continue until late 2024 or early 2025. Data collection will be completed in 2025 or 2026. CONCLUSIONS: Findings from this study will inform the promotion of high-quality screening and brief intervention efforts in pediatric primary care with the aim of reducing alcohol-related morbidity and mortality during adolescence and beyond. TRIAL REGISTRATION: ClinicalTrials.gov NCT04450966; https://www.clinicaltrials.gov/study/NCT04450966. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/55039.

Addressing adverse social determinants of health in pediatric primary care: Study protocol for a hybrid type 2 effectiveness-implementation randomized controlled trial in two national pediatric practice-based research networks.

BACKGROUND: Growing evidence linking social determinants of health (SDOH) to child health outcomes has prompted widespread recommendations for pediatricians to screen and refer for adverse SDOH at primary care visits. Yet there is little evidence to date demonstrating the effectiveness of practice-based SDOH screening and referral interventions on increasing family engagement with resources. This hybrid type 2 effectiveness-implementation trial aims to demonstrate the non-inferiority of a low-touch implementation strategy in order to facilitate dissemination of an existing SDOH screening and referral system (WE CARE) and demonstrate its effectiveness and sustainability in various pediatric practices. METHODS: We recruited eighteen pediatric practices in fourteen US states through two pediatric practice-based research networks. For this stepped wedge cluster RCT, practices serve as their own controls during the Usual Care phase and implement WE CARE during the intervention phase via one of two randomized implementation strategies: self-directed, pre-recorded webinar vs. study team-facilitated, live webinar. We collect data at practice, clinician/staff, and parent levels to assess outcomes grounded in the Proctor Conceptual Model of Implementation Research. We use generalized mixed effects models and differences in proportions to compare rates of resource referrals by implementation strategy, and intention-to-treat analysis to compare odds of engagement with new resources among families enrolled in the Usual Care vs. WE CARE phases. DISCUSSION: Findings from this trial may inform decisions about broader dissemination of SDOH screening systems into a diverse spectrum of pediatric practices across the US and potentially minimize the impact of adverse SDOH on children and families.

The Role of Vitamin D and Its Molecular Bases in Insulin Resistance, Diabetes, Metabolic Syndrome, and Cardiovascular Disease: State of the Art.

In the last decade, an increasing awareness was directed to the role of Vitamin D in non-skeletal and preventive roles for chronic diseases. Vitamin D is an essential hormone in regulating calcium/phosphorous balance and in the pathogenesis of inflammation, insulin resistance, and obesity. The main forms of vitamin D, Cholecalciferol (Vitamin D3) and Ergocalciferol (Vitamin D2) are converted into the active form (1,25-dihydroxyvitamin D) thanks to two hydroxylations in the liver, kidney, pancreas, and immune cells. Some anti-inflammatory cytokines are produced at higher levels by vitamin D, while some pro-inflammatory cytokines are released at lower levels. Toll-Like Receptor (TLR) expression is increased, and a pro-inflammatory state is also linked to low levels of vitamin D. Regardless of how it affects inflammation, various pathways suggest that vitamin D directly improves insulin sensitivity and secretion. The level of vitamin D in the body may change the ratio of pro- to anti-inflammatory cytokines, which would impact insulin action, lipid metabolism, and the development and function of adipose tissue. Many studies have demonstrated an inverse relationship between vitamin D concentrations and pro-inflammatory markers, insulin resistance, glucose intolerance, metabolic syndrome, obesity, and cardiovascular disease. It is interesting to note that several long-term studies also revealed an inverse correlation between vitamin D levels and the occurrence of diabetes mellitus. Vitamin D supplementation in people has controversial effects. While some studies demonstrated improvements in insulin sensitivity, glucose, and lipid metabolism, others revealed no significant effect on glycemic homeostasis and inflammation. This review aims to provide insight into the molecular basis of the relationship between vitamin D, insulin resistance, metabolic syndrome, type 1 and 2 diabetes, gestational diabetes, and cardiovascular diseases.

Examination of Text Message Plans and Baseline Usage of Families Enrolled in a Text Message Influenza Vaccine Reminder Trial: Survey Study.

BACKGROUND: Mobile health (mHealth) is quickly expanding as a method of health promotion, but some interventions may not be familiar or comfortable for potential users. SMS text messaging has been investigated as a low-cost, accessible way to provide vaccine reminders. Most (97%) US adults own a cellphone and of those adults most use SMS text messaging. However, understanding patterns of SMS text message plan type and use in diverse primary care populations needs more investigation. OBJECTIVE: We sought to use a survey to examine baseline SMS text messaging and data plan patterns among families willing to accept SMS text message vaccine reminders. METHODS: As part of a National Institutes of Health (NIH)-funded national study (Flu2Text) conducted during the 2017-2018 and 2018-2019 influenza seasons, families of children needing a second seasonal influenza vaccine dose were recruited in pediatric primary care offices at the time of their first dose. Practices were from the American Academy of Pediatrics' (AAP) Pediatric Research in Office Settings (PROS) research network, the Children's Hospital of Philadelphia, and Columbia University. A survey was administered via telephone (Season 1) or electronically (Season 2) at enrollment. Standardized (adjusted) proportions for SMS text message plan type and texting frequency were calculated using logistic regression that was adjusted for child and caregiver demographics. RESULTS: Responses were collected from 1439 participants (69% of enrolled). The mean caregiver age was 32 (SD 6) years, and most children (n=1355, 94.2%) were aged 6-23 months. Most (n=1357, 94.3%) families were English-speaking. Most (n=1331, 92.8%) but not all participants had an unlimited SMS text messaging plan and sent or received texts at least once daily (n=1313, 91.5%). SMS text messaging plan type and use at baseline was uniform across most but not all subgroups. However, there were some differences in the study population's SMS text messaging plan type and usage. Caregivers who wanted Spanish SMS text messages were less likely than those who chose English to have an unlimited SMS text messaging plan (n=61, 86.7% vs n=1270, 94%; risk difference -7.2%, 95% CI -27.1 to -1.8). There were no significant differences in having an unlimited plan associated with child's race, ethnicity, age, health status, insurance type, or caregiver education level. SMS text messaging use at baseline was not uniform across all subgroups. Nearly three-quarters (n=1030, 71.9%) of participants had received some form of SMS text message from their doctor's office; most common were appointment reminders (n=1014, 98.4%), prescription (n=300, 29.1%), and laboratory notifications (n=117, 11.4%). Even the majority (n=64, 61.5%) of those who did not have unlimited plans and who texted less than daily (n=72, 59%) reported receipt of these SMS text messages. CONCLUSIONS: In this study, most participants had access to unlimited SMS text messaging plans and texted at least once daily. However, infrequent texting and lack of access to an unlimited SMS text messaging plan did not preclude enrolling to receive SMS text message reminders in pediatric primary care settings.

Pediatric Practices' Perceptions of Text Message Communication with Families: An American Academy of Pediatrics (AAP), Pediatric Research in Office Settings (PROS) Study.

Background: Text messages can be an effective and low-cost mechanism for patient reminders; however, they are yet to be consistently integrated into pediatric primary care. Objective: The aim of this study was to explore pediatric primary care clinician and staff perceptions of pediatric office text message communication with families. Methods: As part of the National Institutes of Health-funded Flu2Text randomized controlled trial of second-dose influenza vaccine text message reminders, we conducted 7 focus groups and 4 individual interviews in July-August 2019 with primary care pediatric clinicians and staff (n = 39). Overall, 10 Pediatric Research in Office Settings (PROS) pediatric practices in 10 states were selected using stratified sampling. Semi-structured discussion guides included perspectives on possible uses, perceived usefulness, and ease of use of text messages; practices' current text messaging infrastructure; and perceived barriers/facilitators to future use of texting. Two investigators independently coded and analyzed transcripts based on the technology acceptance model using NVIVO 12 Plus (intercoder reliability, K = 0.86). Results: Overall, participants were supportive of text reminders for the second-dose influenza vaccine, other vaccines, and appointments and perceived texting as a preferred method of communication for caregivers. Health information privacy and patient confidentiality were the main concerns cited. Only respondents from practices with no internal appointment text message reminder system prior to the study expressed concerns about technology implementation logistics, time, and cost. Conclusion: Text message reminders, for various uses, appear to be well accepted among a group of geographically widespread pediatric practices after participation in a trial of influenza vaccine text message reminders. Privacy, confidentiality, and resource barriers need to be addressed to facilitate successful implementation.

Text Message Reminders for the Second Dose of Influenza Vaccine for Children: An RCT.

BACKGROUND AND OBJECTIVES: Among children requiring 2 influenza doses in a given season, second dose receipt nearly halves the odds of influenza. Nationally, many children do not receive both needed doses. This study sought to compare the effectiveness of text message reminders with embedded interactive educational information versus usual care on receipt and timeliness of the second dose of influenza vaccine. METHODS: This trial took place over the 2017 to 2018 and 2018 to 2019 influenza seasons among 50 pediatric primary care offices across 24 states primarily from the American Academy of Pediatrics' Pediatric Research in Office Settings practice-based research network. Caregiver-child dyads of children 6 months to 8 years in need of a second influenza vaccination that season were individually randomized 1:1 into intervention versus usual care, stratified by age and language within each practice. Intervention caregivers received automated, personalized text messages, including educational information. Second dose receipt by April 30 (season end) and by day 42 (2 weeks after second dose due date) were assessed using Mantel Haenszel methods by practice and language. Analyses were intention to treat. RESULTS: Among 2086 dyads enrolled, most children were 6 to 23 months and half publicly insured. Intervention children were more likely to receive a second dose by season end (83.8% versus 80.9%; adjusted risk difference (ARD) 3.8%; 95% confidence interval [0.1 to 7.5]) and day 42 (62.4% versus 55.7%; ARD 8.3% [3.6 to 13.0]). CONCLUSIONS: In this large-scale trial of primary care pediatric practices across the United States, text message reminders were effective in promoting increased and timelier second dose influenza vaccine receipt.

Estimativas de necessidade, oferta e distribuição territorial de leitos neonatais de terapia intensiva e de cuidado intermediário no estado do Rio de Janeiro, de 2012 a 2020 / Estimates of need, supply and territorial distribution of neonatal intensive care and intermediate care beds in the state of Rio de Janeiro, from 2012 to 2020

O cuidado intensivo neonatal é ferramenta essencial para a assistência de recém- nascidos graves ou potencialmente graves, a fim de diminuir a morbimortalidade neonatal. O objetivo do estudo foi analisar a oferta e distribuição territorial dos leitos intensivos e de cuidados intermediários neonatais, no estado do Rio de Janeiro, de 2012 a 2020 e estimar as necessidades e avaliar sua suficiência considerando o ano de 2020. Foi realizado estudo de caráter exploratório, correspondendo a uma avaliação normativa, com delineamento do tipo transversal e abordagem quantitativa. As fontes de dados utilizadas foram o CNES, para o levantamento dos leitos neonatais e suas modalidades, e o Sistema Nacional de Nascidos Vivos (SINASC-RJ) para obtenção do número de nascidos vivos (NV), em 2020. Para estimativa de necessidades e avaliação da suficiência de leitos neonatais, no ano de 2020, adotou-se os parâmetros propostos na Portaria GM/MS nº 930/2012. A estimativa de leitos necessários considerou dois cenários, onde o primeiro contemplou os usuários que utilizam exclusivamente o SUS (100% dos NV, excluídos os beneficiários de planos privados de saúde), e o segundo, 100% dos NV. Os resultados do estudo apontaram que, ao longo da série histórica, houve queda de 3,3% no total de leitos neonatais disponíveis ao SUS, aumento de 66,7% dos leitos de Unidade de Terapia Intensiva Neonatal (UTIN) tipos II e III disponíveis ao SUS, e redução dos leitos de UTIN I. Os leitos de cuidado intermediário neonatal convencional (UCINCo), que representaram a maior parte dos leitos de cuidado intermediário, tiveram redução de cerca de 43%. Os leitos de cuidados intermediários canguru, que constituíram parcela pequena dos leitos neonatais em toda a série histórica (média de 4%), tiveram aumento progressivo ao longo do período estudado. Verificou-se suficiência dos leitos de terapia intensiva no ano de 2020, mas com desigualdades regionais importantes. Foram apontados déficits tanto de leitos de convencionais quanto canguru (UCINCa), estes últimos com situação deficitária em todas as regiões do Estado. Conclui-se que as regiões não estão organizadas sob uma linha de cuidados progressivos, com as três tipologias de leitos previstas na legislação. Há necessidade de investimento na Rede Neonatal estadual, com ampliação dos leitos de todas as modalidades, de forma regionalizada, a fim de melhorar o acesso, evitar o transporte do RN e contribuir para a redução da morbimortalidade neonatal. O estudo pode trazer subsídios ao planejamento dentro da área de cuidado neonatal, baseado na equidade no acesso aos leitos disponíveis no SUS, em particular no Estado do Rio de Janeiro.

Neonatal intensive care is an essential tool for the aid of newborns in serious or potentially serious conditions, in order to reduce neonatal morbidity and mortality. The purpose of this study was to analyze the supply and territorial distribution of intensive and intermediate neonatal care beds in the state of Rio de Janeiro, from 2012 to 2020, estimate their needs and evaluate their sufficiency for the year 2020. It was an exploratory study, corresponding to a normative assessment, with a cross-sectional design and a quantitative approach. The databases used were National Register Health Establishments (CNES) for the survey of neonatal beds and their modalities, and the National Live Birth System (SINASC-RJ) for obtaining the number of live births (LB) in 2020. In order to estimate needs and assess the sufficiency of neonatal beds, in 2020, the parameters proposed in Ordinance GM/MS number 930/2012 were used as a basis. The estimate of beds needed was based on two scenarios, in which the first considered who exclusively uses the SUS (100% of LB, excluding beneficiaries of private health insurance), and the second, 100% of LB. The results of the study showed that, throughout the historical series, there was a 3.3% decrease in the total number of neonatal beds available to SUS, an increase of 66.7% in the number of beds of Neonatal Intensive Care Unit types II and III, available to SUS, and a reduction of beds in Neonatal Intensive Care Unit type I. Neonatal Conventional Intermediate Care beds, which accounted for the majority of intermediate care beds, were reduced about 43%. The kangaroo intermediate care beds, which represented a small portion of neonatal beds throughout the historical series (average of 4%), had a progressive increase over the study`s period. This research observed that there is a sufficiency of intensive care beds, in 2020, but concerning regional inequalities. As for the intermediate care beds, deficits were identified in both conventional and kangaroo beds, the latter with a deficit situation in all regions. It is concluded that the regions are not organized under a progressive care line, with the three types of beds provided for in the legislation. Therefore, there is a need for investment in the state Neonatal Network, with expansion of beds of all modalities, in a regionalized way, in order to improve access, avoid the transportation of the newborns and contribute to reduce neonatal morbidity and mortality. To summarize, the study can provide, to the health system and researchers, subsidies for planning within the area of neonatal care, based on equity in access to beds available at SUS, particularly in the State of Rio de Janeiro.

Cumulative risk factors and mental health of mothers of infants admitted to the neonatal intensive care unit.

Purpose: The present study examined predictive linkages between multiple risk factors and their contribution to the development of anxiety and depression in Puerto Rican mothers of infants admitted to the Neonatal Intensive Care Unit (NICU).Method: The scales used were: the Hamilton Anxiety Rating Scale, the Edinburgh Postpartum Depression Scale, the Hollingshead, and a Demographic Questionnaire was constructed to obtain information about mother and infant characteristics.Results: Both the cumulative psychosocial risk factor (B = 0.267, p = .011) and the cumulative neonatal risk factor (B = -0.220, p = .039) were significant predictors of mothers' anxiety.Discussion: It could be beneficial to create psychosocial interventions in the NICU to address parents' needs and promote emotional resilience. Also, training staff to provide an adequate explanation to mothers, regarding the infants' recovery process is of particular importance.

Escolhas de Sofia e a pandemia de COVID-19 no Brasil: reflexões bioéticas / Escuelas de Sofia y la pandemia de COVID-19 en Brasil: reflexiones bioéticas / Choices of Sofia and the pandemic of COVID-19 in Brazil: Bioethical reflections / Escoles de Sofia I la pandèmia de COVID-19 a Brasil: reflexions bioètiques

Pretende-se mostrar como a pandemia de COVID-19 causada pelo novo coronavírus Sars-CoV-2, afeta a distribuição equitativa de recursos sanitários no Brasil, bem como evidenciar os dilemas e entraves éticos e psicológicos vivenciados pelos profissionais da saúde no contexto de combate à doença. O presente estudo objetivou revisar conhecimentos acerca de questões bioéticas referentes à escassez de recursos e saúde mental. Realizou-se, desse modo, uma análise de protocolos sobre alocação de recursos recém-publicados no Brasil

Se pretende mostrar cómo la pandemia de COVID-19 causada por el nuevo coronavirus Sars-CoV-2, afecta la distribución equitativa de los recursos de salud en Brasil, así como resaltar los dilemas y barreras éticas y psicológicas advertidas por los profesionales de la salud en el contexto de lucha contra la enfermedad. El presente estudio tuvo como objetivo revisar el conocimiento sobre cuestiones bioéticas relacionadas con la escasez de recursos y la salud mental. Así, se realizó un análisis de protocolos sobre la asignación de recursos recientemente publicados en Brasil

It is intended to show how the COVID-19 pandemic caused by the new Sars-CoV-2 coronavirus, affects the equitable distribution of health resources in Brazil, as well as to highlight the ethical and psychological dilemmas and barriers experienced by health professionals in the context of fighting disease. The present study aimed to go through knowledge about bioethical issues related to the scarcity of resources and mental health. Thus, an analysis of protocols on the allocation of newly published resources in Brazil was carried out

Es pretén mostrar com la pandèmia de COVID-19 causada pel nou coronavirus Sars-COV-2, afecta la distribució equitativa dels recursos de salut al Brasil, així com ressaltar els dilemes I les barreres ètiques I psicològiques reconegudes pels professionals de la salut en el context de lluita contra la malaltia. El present estudi va tenir com a objectiu revisar el coneixement sobre qüestions bioètiques relacionades amb l'escassetat de recursos I la salut mental. Així, es va realitzar una anàlisi de protocols sobre l'assignació de recursos recentment publicats al Brasil

Vaccine hesitancy and influenza beliefs among parents of children requiring a second dose of influenza vaccine in a season: An American Academy of Pediatrics (AAP) Pediatric Research in Office Settings (PROS) study.

To receive adequate protection against influenza, some children 6 months through 8 y old need two doses of influenza vaccine in a given season. Currently, only half of those receiving the first dose receive a second. Our objective was to assess vaccine hesitancy and influenza disease and vaccine knowledge, attitudes, and beliefs among caregivers of children who received the first of their two needed doses. As part of a national-randomized control trial of second dose text-message influenza vaccine reminders (2017-2018 season), a telephone survey collected caregiver and index child demographic information. Each child had received the first of two needed influenza vaccine doses. Caregivers completed a measure of general vaccine hesitancy - the five-question Parent Attitudes About Childhood Vaccines Survey Tool (PACV-5) - and questions about influenza infection and vaccine. We assessed associations between participant demographic characteristics, vaccine hesitancy, and influenza beliefs and calculated the standardized proportion of caregivers endorsing each outcome using logistic regression. Analyses included responses from 256 participants from 36 primary care practices in 24 states. Some caregivers (11.7%) reported moderate/high vaccine hesitancy and many had misperceptions about influenza disease and vaccine. In multivariable models, no single variable was consistently associated with inaccurate knowledge, attitudes, and beliefs. These results demonstrate that caregivers whose children received the first dose of influenza vaccine may still be vaccine hesitant and have inaccurate influenza beliefs. Pediatricians should consider broadly addressing inaccurate beliefs and promoting vaccination even after caregivers agree to the first dose.

The Impact of a Peer Navigator Program in Addressing the Health Needs of Latinos With Serious Mental Illness.

OBJECTIVE: The impact of a peer navigator program (PNP) on efforts to address the health needs of Latinos with serious mental illness was examined in a randomized controlled trial. METHODS: Latinos with a serious mental illness (N=110) were randomly assigned to the PNP (integrated care with a peer navigator [PN]) or to a treatment-as-usual control group (integrated care without a PN) for one year. Data on service engagement (scheduled and received appointments) were assessed weekly, and self-reports of recovery, empowerment, and quality of life were collected at baseline and at four, eight, and 12 months. RESULTS: Findings from group × trial analyses of covariance (ANCOVAs) found main and interaction effects for scheduled and achieved appointments, showing better engagement for the PNP group compared with the control group over the course of the study. Significant interactions were found for recovery, empowerment, and quality of life, showing greater improvement for the PNP group compared with the control group over year 1 of the study (multivariate ANCOVA; F=3.27, df=9 and 98, p<.01). CONCLUSIONS: In-the-field navigation by peers seems to enhance service engagement, recovery, and quality of life. Whether these results occurred because navigators helped overcome barriers to treatment-regardless of whether they were peers per se-needs to be examined in future research.

Qualitative Evaluation of a Peer Navigator Program for Latinos with Serious Mental Illness.

Peer navigator programs (PNP) may help reduce physical health disparities for ethnic minorities with serious mental illness (SMI). However, specific aspects of PNP that are important to peer navigators and their clients are under-researched. A qualitative study explored the perspectives of service users (n = 15) and peer navigators (n = 5) participating in a randomized controlled trial of a PNP for Latinos with SMI. Results show PN engagement with service users spans diverse areas and that interactions with peers, trust, and accessibility are important from a service user perspective. PNs discussed needs for high-quality supervision, organizational support, and additional resources for undocumented Latinos.

The Healthcare Needs of Latinos with Serious Mental Illness and the Potential of Peer Navigators.

Latinos with serious mental illness get sick and die much younger than other adults. In this paper, we review findings of a community based participatory research project meant to identify important healthcare needs, barriers to these needs, solutions to the barriers, and the promise of peer navigators as a solution. Findings from focus groups reflected general concerns of people with mental illness (e.g., insurance, engagement, accessibility) and Latinos with serious mental illness (e.g., immigration, language, and family). Feedback and analyses especially focused on the potential of peer navigators. Implications of these findings for integrated care of Latinos with serious mental illness are discussed.

Prioritizing the healthcare needs of Latinos with mental illness.

Latinos with serious mental illness have higher morbidity and mortality rates than same age peers. In this paper, we review findings of a community based participatory research project meant to identify important health needs of this group, barriers to these needs, solutions to the barriers and the promise of peer navigators as a solution. Findings from a prior qualitative study yielded 84 themes related to needs, barriers and solutions. These findings were transposed into individual items, to which 122 Latino participants with mental illness responded using a 7-point importance scale. Results showed item importance means ranging from 4.34 to 5.47, with counseling/therapy services and mental health treatment topping the list for healthcare needs. Analyses also examined differences between those born in the USA versus those born elsewhere. Latinos who were native to the USA differed significantly from those born abroad in over one quarter of importance ratings. Implications of these findings for integrated care of Latinos with serious mental illness are discussed.

Precisão da retinoscopia sem lentes neutralizadoras na hipermetropia experimental de olho artificial / Accuracy limits of retinoscopy without neutralising lenses for evaluation of experimental hypermetropia in a model eye

OBJETIVO: Avaliar a acurácia e a precisão da retinoscopia sem lentes neutralizadoras na hipermetropia experimental de olho artificial. MÉTODOS: Observação da projeção da faixa do retinoscópio em olho artificial preparado para apresentar hipermetropias de +1,00 D a +8,00 D. A movimentação da faixa é feita simultaneamente com a variação da sua largura, deslocando a luva do retinoscópio até a obtenção da neutralização do movimento. O retinoscópio foi preparado para dois modos de medida: com escala milimétrica sob a luva e com acoplamento a potenciômetro ligado a multímetro de leitura digital em ohms (Ù). Oito médicos oftalmologistas realizaram 1200 retinoscopias em cada modo de medida, num total de 2400. Calculou-se a média e o desvio padrão das observações. Para comparar os resultados em mm e em ohms (Ù) calculou-se o coeficiente de variação (CV) a partir dos desvios padrão das observações em cada modo. RESULTADOS: Pelos modos descritos foi possível estimar hipermetropias até +4,00 dioptrias. CONCLUSÃO: A acurácia e a reprodutibilidade experimentais foram boas na identificação de hipermetropias até +4 ,00 D.

OBJECTIVE: Evaluate accuracy and reproducibility of streak retinoscopy without neutralising lenses in experimental hyperopia of an artificial eye. METHODS: Observe a Welsh Allynretinoscope streak through the pupil of an artificial eye prepared do show hyperopia from +1,00 D to +8,00 D. The streak was moved while varying its width by sliding the sleeve upwards until neutralisation point. The retinoscope was fitted either with a millimetre scale under the sleeve or with a multimetre connected to a rheostat driven by a spool snugly fastened around the sleeve. Multimetre readings were taken in ohms (Ù). Eight ophthalmologists performed 1200 in each mode totalysing 2400 readings. Average and standard deviation of the readings in each mode were determined, as well as the variation coefficient in order to allow comparison of results in millimetre and Ù. RESULTS: Based on the proposed method it was possible to estimate hyperopia up to +4,00 D. CONCLUSION: Accuracy and reproducibility in experimental hyperopia of an artificial eye was feasible up to +4,00 D.

Notificação de eventos adversos em vigilância sanitária: incompletitude das variáveis do NOTIVISA em 2007 E 2008. / Notification of adverse events in Sanitary Surveillance: variables incompleteness in Notivisa from 2007 to 2008.

A informação é instrumento fundamental para o processo decisório na vigilância póscomercialização/ uso, que tem por finalidade promover a identificação precoce de eventos adversos (EAs) relacionados com o uso de produtos sob vigilância sanitária. Este estudo avaliou aqualidade da informação, utilizando o indicador incompletitude das variáveis dos formulários das notificações de EA de uso de sangue e componentes (10), vacinas e imunoglobulinas (39), equipamentos (31) e artigos (30) médico-hospitalares recebidos pelo Notivisa em 2007 e2008. Trata-se de estudo transversal e descritivo. No ano de 2007, apenas 3 (30,0%); 6 (15,4%); 6 (19,4%) e 6 (20%) variáveis apresentaram taxa de incompletitude com classificação bom ouexcelente, respectivamente. Já em 2008, foram 4 (40,0%); 7 (17,9%); 7 (22,9%) e 7 (23,3%), porém as variáveis não foram as mesmas. Os resultados indicam que houve elevada incompletitude para a maior parte das variáveis estudadas. A instrumentalização para subsidiara vigilância pós-comercialização/uso está em construção no âmbito do Sistema Nacional de Vigilância Sanitária. Estratégias com melhoria do preenchimento das variáveis devem ser implementadas para contribuir com informações robustas na tomada decisão.

Information is essential to support the decision making process in post marketing surveillance. It aims to promote the early identification of adverse events (AE) related to the use of products under surveillance. This study aimed to evaluate information quality, using variables incompleteness of the notification forms of AE related to blood and its components use (10), vaccines and immunoglobulin (39), health care equipments (31) and medical devices (30) received by Notivisain 2007 and 2008. This is a transversal and descriptive study. In the year of 2007, only 3 (30%); 6 (15.4%); 6 (19.4%) and 6 (20%) variables presented incompleteness ratio with good or excellent classification, respectively. In 2008, there were 4 (40%), 7 (17.9%), 7 (22.9%) and 7 (23.3%), although the variables were not the same. The results indicate that the incompleteness for most of the studied variables increased. The instrumentation to subside the post marketing surveillance is still being constructed under the Sistema Nacional de Vigilância Sanitária (Brazilian national sanitary surveillance system). Strategies to improve the data s filling out must be implemented in order to provide relevant information to decision makers.

Notificação de eventos adversos em vigilância sanitária: preenchimento dos dados do notivisa em 2007 e 2008 / Notification of adverse events in health surveillance: data filling out of notivisa in 2007 and 2008

A informação é instrumento fundamental para o processo decisório na vigilância pós-comercialização/uso, que tem por finalidade promover a identificação precoce de eventos adversos (EA) relacionados com o uso de produtos sob vigilância sanitária. Este estudo avaliou o preenchimento dos campos dos formulários das notificações de EA de uso de sangue e componentes, vacinas e imunoglobulinas, equipamentos e artigos médico-hospitalares recebidas pelo Notivisa em 2007 e 2008. Trata-se de estudo transversal, exploratório, descritivo e quantitativo. Os resultados evidenciaram que no ano de 2007 foram registradas 1.972 notificações de EA. Destas, 1.804 (91,5%) relativas ao uso de sangue ou componentes; 16 (0,8%) de vacinas e imunoglobulinas; 13 (0,7%) de equipamentos e 139 (7,0%) de artigos. Em 2008, foram 2.915 notificações de EA sendo: 2.632 (90,3%) relativas ao uso de sangue ou componentes; 36 (1,2%) de vacinas e imunoglobulinas; 21 (0,7%) de equipamentos e 226 (7,8%) de artigos. As taxas de incompletitude sugerem uma sub notificação da maior parte das informações contidas nas variáveis não obrigatórias das notificações. A instrumentalização para subsidiar a vigilância pós-comercialização/uso está em construção no âmbito do Sistema Nacional de Vigilância Sanitária. Estratégias para melhoria do preenchimento das variáveis devem ser implementadas para fornecer informações robustas para a tomada decisão.

Morfometria del Acromion y sus Implicancias Clínicas / Morphometry of Acromion and its Clinical Implications

Estudios previos demostraron que la morfología del acromion y sus respectivas relaciones con el tubérculo supraglenoideo y el proceso coracoides, son de fundamental importancia en la determinación del espacio subacromial. Las variaciones de estas estructuras pueden provocar el principio del síndrome del impacto, también conocido como síndrome del pinzamiento del espacio subacromial. Sin embargo, se observa la falta de relatos en la literatura sobre los diferentes padrones morfométricos del acromion. El objetivo de este estudio fue establecer un padrón morfométrico del acromion, a través de la determinación de su largo, grosor y proyección anterior, además de determinar su relación con el proceso coracoides y el tubérculo supraglenoideo. Fueron analizadas 60 escápulas (37 derechas y 23 izquierdas) de individuos adultos, de la colección de piezas óseas del Departamento de Anatomía de la Universidad Federal de Pernambuco, Brasil. Con la ayuda de un paquímetro y una cinta métrica de perimetría fueron realizadas medidas del largo, grosor y proyección anterior del acromion y también de las distancias del acromion al tubérculo supraglenoideo y al proceso coracoides. Los resultados obtenidos fueron: largo del acromion: 4,96cm + 0,46 (74%); grosor: 0,72cm + 0,1 (72%); proyección anterior: 4,llcm + 0,42 (67%); distancia entre el acromion y el tubérculo supraglenoideo: 2,95cm + 0,35 (67%); distancia entre el acromion y el proceso coracoides: 3,8cm + 0,52 (64%). No observamos variaciones entre las escápulas derechas e izquierdas. El análisis morfométrico del acromion debe ser utilizado como base auxiliar para los estudios, procurando un mejor conocimiento de las patologías que existen en esa región.

Previous studies demonstrated that the morphology of the acromion and its respective relations with the uppermost point of the glenoid and the coracoid process is very important in the determination of subacromial space. The variations of these structures can predispose the beginning of the Impingement Syndrome. However, there is a shortage of reports on hterature about the different acromion's morphometric samples. The purpose of this study was to determine a morphologic pattern of the acromion, through the determination of its length, thickness, front projection, and its relation with the uppermost point of the glenoid and the coracoid process. We used 60 scapulae (37 right and 23 left) of adults from Departamento de Anatomia da Universidade Federal de Pernambuco, Brazil. To measure the length, thickness and front projection of acromion, and the distances from acromion to the uppermost point of the glenoid and to the coracoid process were used a calipers and a tape measure. We found these results: acromion length: 4.96cm + 0.46 (74%); thickness: 0.72cm + 0.1 (72%); front projection: 4.11cm + 0.42 (67%); distance between acromion and the uppermost point of the glenoid: 2.95cm + 0.35 (67%); distance between acromion and coracoid process: 3.8cm + 0.52 (64%). We did not find differences between right and left scapulaes. The morphometric analysis of the acromion should be used like an auxiliary basis to studies that promote a better knowledge about the disease that appear in this area.