Implementation Science of Telepsychotherapy for Anxiety, Depression, and Somatization in Health Care Workers Dealing with COVID-19.

Introduction: Cognitive behavioral therapy (CBT) has proven to be effective in treating affective and somatic symptoms, which are among the leading mental health problems of health care workers (HCWs) dealing with COVID-19 (HCW-COVID-19). However, efforts to develop and evaluate the strategies required to promote its implementation in clinical practice are still scarce, particularly in low- and middle-income countries. Objective: To describe and evaluate the implementation process and clinical impact of a brief, remote, manualized CBT-based intervention for moderate anxiety, depressive, and somatic symptoms among Mexican HCW-COVID-19 ≥18 years old. Methods: The implementation process comprises community engagement, intervention systematization and education, leadership engagement, and team-based coaching as main strategies. A total of 26 participants completed self-report measures of symptoms before and after treatment, and a subsample of 21 answered a final questionnaire on the acceptability of the intervention. Therapists registered the techniques used in each case, regardless of whether they were part of the intervention manual. Results: The number of sessions was 4.6 (2.43). The most frequently employed techniques were those included in the intervention manual, especially identifying and modifying maladaptive thoughts, used to treat 70% of HCW-COVID-19. Supplementary techniques were implemented to enhance treatment or meet HCW-COVID-19s special needs (such as workplace issues, insomnia, COVID-19 status, and bereavement). The intervention had a significant effect (delta Cohen's coefficients ≥1), and the majority of HCW-COVID-19 were "totally satisfied" with its contents and considered it "not complex" (95.2% and 76.1%, respectively). Conclusions: Telepsychotherapy for anxiety, depression, and somatization in HCW coping with health emergencies in middle-income countries is a feasible, clinically valuable, and acceptable form of treatment.

INDICATION FOR LIVER TRANSPLANTATION DUE TO HEPATOCELLULAR CARCINOMA: ANALYSIS OF 1,706 PROCEDURES OVER THE PAST DECADE IN THE STATE OF PARANÁ.

BACKGROUND: Patients listed for liver transplantation and hepatocellular carcinoma are considered priority on the waiting list, and this could overly favor them. AIM: This study aimed to evaluate the impact of this prioritization. METHODS: We analyzed the liver transplants performed in adults from 2011 to 2020 and divided into three groups: adjusted Model of End-Stage Liver Disease (MELD) score for hepatocellular carcinoma, other adjusted Model of End-Stage Liver Disease situations, and no adjusted Model of End-Stage Liver Disease. RESULTS: A total of 1,706 patients were included in the study, of which 70.2% were male. Alcoholism was the main etiology of cirrhosis (29.6%). Of the total, 305 patients were with hepatocellular carcinoma, 86 with other adjusted Model of End-Stage Liver Disease situations, and 1,315 with no adjusted Model of End-Stage Liver Disease. Patients with hepatocellular carcinoma were older (58.9 vs. 53.5 years). The predominant etiology of cirrhosis was viral hepatitis (60%). The findings showed that group with adjusted Model of End-Stage Liver Disease had lower physiological Model of End-Stage Liver Disease (10.9), higher adjusted Model of End-Stage Liver Disease (22.6), and longer waiting list time (131 vs. 110 days), as compared to the group with no adjusted Model of End-Stage Liver Disease. The total number of transplants and the proportion of patients transplanted for hepatocellular carcinoma increased from 2011 to 2020. There was a reduction in the proportion of patients with hepatocellular carcinoma and adjusted Model of End-Stage Liver Disease of 20 and there was an increase on waiting list time in this group. There was an increase in the proportion of those with adjusted Model of End-Stage Liver Disease of 24 and 29, but the waiting list time remained stable. CONCLUSION: Over the past decade, prioritization of hepatocellular carcinoma resulted in an increased proportion of transplanted patients in relation to those with no priority. It also increased waiting list time, requiring higher adjusted Model of End-Stage Liver Disease to transplant an organ.

Adaptación cultural mexicana del programa de intervención CASCAdE para padres de supervivientes de cáncer infantil / Mexican cultural adaptation of the CASCAdE intervention program for parents of childhood cancer survivors

Objetivo:Describir el proceso de adaptación cultural del programa CASCAdE en línea para padres de supervivientes de cáncer infantil mexicanos. Método: Se utilizó el Modelo Ecológico de Validación (MEV), en dos fases: la primera consistió en la traducción (inglés-español) y adaptación cultural de los contenidos del programa; la segunda fue la evaluación del contenido e integridad del tratamiento. Resultados:Se realizaron cambios en la redacción del texto, se modificó el uso de la segunda persona del singular por la tercera persona del singular “usted”. Del MEV se eligieron para adaptación de materiales: Lenguaje, Personas, Metáforas o dichos, Narrativa y Conceptos. Entre los cambios más relevantes se encuentran el uso de la tercera persona del singular (aceptabilidad) y la adaptación de metáforas que fueran entendibles en este contexto (relevancia). Para la intervención se adaptaron: Métodos, contexto y objetivos, dando como resultado la aplicación individual, cambios en el diseño gráfico e inclusión de iconografías llamativas y amigables para los padres (aceptabilidad). En la evaluación del contenido por jueces expertos se obtuvieron porcentajes del 50% de acuerdo en redacción de las sesiones de introducción del manual para el facilitador y 75% en redacción de la sesión cuatro del manual para padres. Conclusión: Este estudio muestra el proceso de adaptación cultural desde el MEV a fin de contar con los materiales necesarios para que la aplicación del programa CASCAdE en un contexto mexicano (AU)

Objective:Describe the process of the cultural adaptation of the CASCAdE intervention program for parents of childhood cancer survivors in Mexico. Method: The Ecological Validation Model (EVM) was used in two stages. The first consisted of the translation (from English to Spanish) and cultural adaptation of the program content while second involved the evaluation of the treatment content and integrity. Results. Changes were made in the wording of the text; the second person singular was changed to the third person singular “usted,” the formal way to say “you” in Spanish. The following were chosen from the EVM for the adaptation of materials: language, people, metaphors, or sayings, narrative and concepts. Among the most relevant changes are the use of the third person singular (acceptability) and the adaptation of metaphors to make them understandable in this context (relevance). The following aspects were adapted for the intervention: methods, context, and objectives, which resulted in individual application, changes in graphic design and the inclusion of attractive images for parents (acceptability). In the content evaluation by expert judges, 50% of agreement was obtained in the writing of the introductory sessions of the facilitator’s manual and 75% in the wording of session four of the parents’ manual. Conclusions. This study shows the process of cultural adaptation based on the EVM to obtain the necessary materials for the implementation of the CASCAdE program in a Mexican context (AU)

Indication for liver transplantation due to hepatocellular carcinoma: analysis of 1,706 procedures over the past decade in the state of paraná / Indicação de transplante hepático por hepatocarcinoma: análise de 1.706 procedimentos na última década no estado do paraná

ABSTRACT BACKGROUND: Patients listed for liver transplantation and hepatocellular carcinoma are considered priority on the waiting list, and this could overly favor them. AIM: This study aimed to evaluate the impact of this prioritization. METHODS: We analyzed the liver transplants performed in adults from 2011 to 2020 and divided into three groups: adjusted Model of End-Stage Liver Disease (MELD) score for hepatocellular carcinoma, other adjusted Model of End-Stage Liver Disease situations, and no adjusted Model of End-Stage Liver Disease. RESULTS: A total of 1,706 patients were included in the study, of which 70.2% were male. Alcoholism was the main etiology of cirrhosis (29.6%). Of the total, 305 patients were with hepatocellular carcinoma, 86 with other adjusted Model of End-Stage Liver Disease situations, and 1,315 with no adjusted Model of End-Stage Liver Disease. Patients with hepatocellular carcinoma were older (58.9 vs. 53.5 years). The predominant etiology of cirrhosis was viral hepatitis (60%). The findings showed that group with adjusted Model of End-Stage Liver Disease had lower physiological Model of End-Stage Liver Disease (10.9), higher adjusted Model of End-Stage Liver Disease (22.6), and longer waiting list time (131 vs. 110 days), as compared to the group with no adjusted Model of End-Stage Liver Disease. The total number of transplants and the proportion of patients transplanted for hepatocellular carcinoma increased from 2011 to 2020. There was a reduction in the proportion of patients with hepatocellular carcinoma and adjusted Model of End-Stage Liver Disease of 20 and there was an increase on waiting list time in this group. There was an increase in the proportion of those with adjusted Model of End-Stage Liver Disease of 24 and 29, but the waiting list time remained stable. CONCLUSION: Over the past decade, prioritization of hepatocellular carcinoma resulted in an increased proportion of transplanted patients in relation to those with no priority. It also increased waiting list time, requiring higher adjusted Model of End-Stage Liver Disease to transplant an organ.

RESUMO RACIONAL: Pacientes portadores de carcinoma hepatocelular com indicação de transplante hepático recebem prioridade na lista de espera e isso poderia favorecê-los demasiadamente. OBJETIVO: Avaliar o impacto dessa priorização. MÉTODOS: Foram analisados os transplantes hepáticos realizados de 2011 até 2020 no estado do Paraná, divididos em três grupos: portadores de carcinoma hepatocelular no modelo para doença hepática terminal (MELD) ajustado, outras situações no modelo para doença hepática terminal ajustado e sem o modelo para doença hepática terminal ajustado. RESULTADOS: Foram incluídos 1.706 pacientes, 70,2% do gênero masculino, a maioria portadores de cirrose alcoólica (29,6%): 305 com hepatocarcinoma, 86 com outras situações no modelo para doença hepática terminal ajustado e 1.315 sem o modelo para doença hepática terminal ajustado. Nos portadores de hepatocarcinoma, a idade média foi maior (58,9 vs 53,5 anos), a etiologia predominante da cirrose foram as hepatites virais (60%), apresentaram menor no modelo para doença hepática terminal fisiológico (10,9), maior no modelo para doença hepática terminal corrigido (22,6 vs 21,8) e maior tempo em lista de espera (131 vs 110 dias) quando comparados ao grupo sem o modelo para doença hepática terminal ajustado. O número de transplantes e a proporção de pacientes transplantados por hepatocarcinoma aumentou de 2011 até 2020. Houve redução da proporção dos portadores de hepatocarcinoma com o modelo para doença hepática terminal de 20 no decorrer da década e aumento do tempo em lista nesse grupo. Para os com modelo para doença hepática terminalde 24 e de 29, houve aumento na proporção e o tempo em lista permaneceu estável. CONCLUSÃO: A priorização do hepatocarcinoma conferiu maior modelo para doença hepática terminal e incremento na proporção de transplantes em relação aos sem prioridade. Também aumentou o tempo em lista de espera, necessitando maior modelo para doença hepática terminal corrigido para obtenção de um órgão.

Acinetobacter Baumannii Multiresistente y su Relación con la Producción de Biopelículas

Resumen Introducción: Acinetobacter baumannii es la bacteria Gram negativa asociada a infecciones intrahospitalarias por su gran facilidad de supervivencia en condiciones adversas y el desarrollo de multirresistencia a diversos antimicrobianos. Durante años se han registrado brotes hospitalarios en diferentes países asociados a esta bacteria, lo que aumentó el interés de estudio de las biopelículas y los genes involucrados en su producción, debido a que se demostró una asociación a la resistencia antibiótica. Objetivos: Establecer relacion entre la multirresistencis a los diferentes antibioticos y la formacion de biopeliculas en aislamientos de Acinetobacter baumannii. Métodos: Se estudió cepas de Acinetobacter baumannii utilizando reacción en cadena de la polimerasa (PCR) en tiempo real para la detección de genes bap, csuE, ompA, oxa-51 de 191 muestras, de igual manera se realizó la cuantificación de la biopelícula formada siguiendo la técnica descrita por Badmasti y Azizi. Resultados: Se realizó este estudio sobre 191 cepas de Acinetobacter baumannii provenientes de dos centros hospitalarios para la identificación de genes asociados a las biopelículas y posterior cuantificación de acuerdo a la técnica descrita por Badmasti y Azizi. Demostrando una asociación entre las biopelículas y la resistencia bacteriana de Acinetobacter baumannii. Conclusiones: Los resultados demostraron una asociación positiva entre la cantidad de biopelícula formada y la resistencia antibiótica, bacterias formadoras fuertes de biopelículas presentan mayor resistencia a los carbapenems. En cuanto a los genes, el gen ompA demostró una asociación con la cantidad de biofilm producido, bap y csuE son genes involucrados en el primer paso de formación de biofilm, pero no se asocian con la cantidad formada por la bacteria.

Abstract Introduction: Acinetobacter baumannii is the Gram-negative bacterium associated with hospital infections due to its great ease of survival in adverse conditions and the development of multi-resistance to various antimicrobials. For years, hospital outbreaks have been registered in different countries associated with this bacterium, which increased the interest in studying biofilms and the genes involved in their production, since an association with antibiotic resistance was demonstrated. Objectives: To establish a relationship between multiresistance to different antibiotics and biofilm formation in Acinetobacter baumannii isolates. Methods: acinetobacter baumannii strains were studied using real-time polymerase chain reaction (PCR) for the detection of bap, csuE, ompA, oxa-51 genes from 191 samples, in addition to the quantification of the biofilm formed following the technique described by Badmasti and Azizi. Results: this study was carried out on 191 Acinetobacter baumannii strains from two hospital centers for the identification of genes associated with biofilms and subsequent quantification according to the technique described by Badmasti and Azizi. Demonstrating an association between biofilms and Acinetobacter baumannii bacterial resistance. Conclusions: the results demonstrated a positive association between the amount of biofilm formed and antibiotic resistance. Strong biofilm-forming bacteria show greater resistance to carbapenems. Regarding the genes, the ompA gene showed an association with the amount of biofilm produced, bap and csuE are genes involved in the first step of biofilm formation, but they are not associated with the amount formed by the bacteria

IDENTIFICACIÓN MICROBIOLÓGICA, MOLECULAR; SEROLÓGICA DE Streptococcus pneumoniae, Y DETERMINACIÓN DE LA SUSCEPTIBILIDAD A PENICILINA Y ERITROMICINA EN LA CIUDAD DE COCHABAMBA / Microbiological molecular identification and serologic of Streptococcus pneumoniae and determination of the suceptibility to penicilin and eritromicin in the city of Cochabamba

Streptococcus pneumoniae es uno de los principales patógenos causantes de infecciones respiratorias e invasivas, por lo que es importante identificar rápidamente este microorganismo y determinar la susceptibilidad a los antibióticos frecuentemente utilizados, para la realización de terapias adecuadas. Con este fin se realizó la identificación de 32 aislamientos de Streptococcus pneumoniae, a partir de pacientes con infecciones respiratorias e invasivas; para su identificación se utilizaron métodos microbiológicos convencionales y como pruebas confirmatorias, métodos moleculares por reacción en cadena de la polimerasa (PCR), amplificando regiones de los genes lyt A y ply y métodos serológicos para la determinación del antígeno capsular. Se realizaron antibiogramas para determinar la susceptibilidad a Penicilina y Eritromicina. Los resultados revelaron, un mayor número de aislamientos en menores de 10 años y en mayores de 49 años y en relación a épocas estacionales, de aislamientos un mayor número durante los meses de invierno. En las pruebas de susceptibilidad a los antibióticos se encontró una sensibilidad disminuida a Penicilina (SDP) de 46.88 %; resistencia a eritromicina de 6.25 % y resistencia intermedia de 15,63%. Realizando un análisis estadístico de los tres métodos como pruebas de reconfirmación, se observó una correlación baja, por lo que la prueba de la optoquina con fines de reconfirmación para Streptococcus pneumoniae, es inferior a las pruebas serológica y molecular.

Streptococcus pneumoniae is one of the main pathogens that cause breathing and invasive infections, that is why is important a quick identification of this microorganism and determine the sensitivity of the frequently used antibiotics, to execute appropriate therapies. With this purpose the identification of 32 isolates of Streptococcus pneumoniae from patients with breathing and invasive infections were carried out, conventional microbiological tests were applied for identification and for confirmation were used molecular techniques based on the chain reaction of polymerase (PCR), amplifying the regions of lyt A and ply genes and serological methods for the determination of the capsular antigen. Antibiograms were carried out in order to determinate the sensitivity to penicillin and erythromycin. The results showed a higher amount of isolates in children under 10 and adults over 49, and according to seasons, more isolates on winter months. Regarding sensitivity to antibiotics, we found a drop of 46.88% to penicillin, a drop of 6.25 to erythromycin and an intermediate drop of 15.63%. The statistical analysis among the three techniques used for reconfirmation revealed there is a low correlation among them. Therefore, optochin, used as a re-confirmation method, is lower than serological and molecular tests.