Advancing health equity: A qualitative study assessing barriers and facilitators of implementing hereditary breast and ovarian cancer risk screening tools in community-based organizations.

Genetic counseling and testing (GCT) inform cancer management for persons at risk for hereditary breast and ovarian cancer (HBOC). Community-based organizations (CBOs) may play a role in identifying at-risk Latinx individuals to connect them to GCT but data are lacking. Two academic centers and their four CBO partners planned to implement a validated questionnaire for HBOC risk screening ("HBOC risk screening tool"). This study aimed to assess CBO's preferences for HBOC risk screening tools, as well as the barriers and facilitators anticipated for future implementation. Pre-implementation focus groups were conducted with CBO's staff. Discussions centered on current practices to identify and refer at-risk patients. During the discussion, staff were asked to select one out of five validated HBOC risk screening tools to implement and to discuss anticipated barriers/facilitators for implementation. The four focus groups were coded and qualitative analyzed following the Consolidated Framework for Implementation Research (CFIR) and Health Equity domains. All CBOs chose the Family History Screen 7 (FHS-7). Participants (N = 35) highlighted how the FHS-7 was easy to adapt to better fit the target population and changing guidelines. They had positive attitudes toward implementing the screening tool, stressed how the culture of the organization positioned them to reach the target population, and noted barriers in different CFIR domains (e.g., low knowledge about HBOC and GCT referrals; scarce available resources). Participants pointed to barriers related to health equity domains including limited access to GCT and follow-up care for uninsured and underinsured populations, challenges obtaining accurate family history, and immigration-related barriers. CBOs highlighted the importance of partnering with other stakeholders to overcome barriers. Findings emphasize the need to develop multi-level implementation strategies to overcome barriers and leverage facilitators. This study can inform the development of implementation toolkits for CBOs to implement HBOC screening tools to advance health equity.

A spanish adaptation of the implicit positive and negative affect test (ipanat) / Adaptación para población española de la escala de afecto positivo y negativo implícitos (IPANAT)

BACKGROUND: Self-report measures of affective states (i.e., explicit measure) underlie a variety of cognitive biasing factors. Therefore, measures for the indirect assessment of affect (i.e., implicit) have previously been developed, such as the Implicit Positive and Negative Affect Test. The IPANAT asks participants to make judgments about the degree to which artificial non-sense words sound like affective states, and has demonstrated good reliability and validity. METHODS: We created a Spanish version of this test (IPANAT-SPAIN). After adapting artificial words to Spanish language, based on preliminary studies, the IPANAT-SPAIN was administered to a representative sample of N = 468 adults from Spain (225 men). Competing models of its latent structure were evaluated using confirmatory factor analysis. To assess convergent validity, we correlated the IPANAT-SPAIN with explicit measures of affect. RESULTS: The best-fitting model consisted of two factors corresponding to positive implicit affect (PA) and negative implicit affect (NA). Reliability of the IPANAT-SPAIN was a = .94 for PA, and a = .88 for NA. The pattern of relationships between the IPANAT-SPAIN and explicit affect measures were consistent with previous findings. CONCLUSIONS: The results indicate that the Spanish adaptation of the IPANAT has satisfactory psychometric properties

ANTECEDENTES: el uso de cuestionarios autoinformados para medir estado afectivo (i.e., medición explícita) puede conllevar sesgos cognitivos. Por ello, se han desarrollado medidas indirectas (i.e., implícitas), como el Test de Afecto Implícito Positivo y Negativo. En el IPANAT las personas deben realizar valoraciones acerca del grado en que creen que palabras artificiales expresan distintos estados afectivos, y ha demostrado buena fiabilidad y validez. MÉTODO: para crear la versión española se realizaron estudios preliminares para adaptar las palabras artificiales. La nueva versión adaptada se administró a una muestra representativa de personas adultas residentes en España (N = 468, 225 hombres). Se realizaron análisis factoriales confirmatorios para corroborar la estructura del instrumento. Asimismo, se correlacionaron las medidas de afecto implícitas con medidas explícitas, para estudiar su validez de convergencia. RESULTADOS: el mejor modelo corresponde a dos factores (PA: afecto implícito positivo y NA: afecto implícito negativo), con coeficientes de fiabilidad de a = .94 y a = .88, respectivamente. Las relaciones entre las medidas del IPANAT-España y las medidas de afecto explícito fueron consistentes con hallazgos previos. CONCLUSIONES: los resultados indican que el IPANAT-España tiene propiedades psicométricas adecuadas

A Spanish adaptation of the implicit positive and negative affect test (IPANAT).

BACKGROUND: Self-report measures of affective states (i.e., explicit measure) underlie a variety of cognitive biasing factors. Therefore, measures for the indirect assessment of affect (i.e., implicit) have previously been developed, such as the Implicit Positive and Negative Affect Test. The IPANAT asks participants to make judgments about the degree to which artificial non-sense words sound like affective states, and has demonstrated good reliability and validity. METHODS: We created a Spanish version of this test (IPANAT-SPAIN). After adapting artificial words to Spanish language, based on preliminary studies, the IPANAT-SPAIN was administered to a representative sample of N = 468 adults from Spain (225 men). Competing models of its latent structure were evaluated using confirmatory factor analysis. To assess convergent validity, we correlated the IPANAT-SPAIN with explicit measures of affect. RESULTS: The best-fitting model consisted of two factors corresponding to positive implicit affect (PA) and negative implicit affect (NA). Reliability of the IPANAT-SPAIN was a = .94 for PA, and a = .88 for NA. The pattern of relationships between the IPANAT-SPAIN and explicit affect measures were consistent with previous findings. CONCLUSIONS: The results indicate that the Spanish adaptation of the IPANAT has satisfactory psychometric properties.

Implicit Affect and Autonomous Nervous System Reactions: A Review of Research Using the Implicit Positive and Negative Affect Test.

In everyday life, affective processes occur spontaneously and typically go along with an automatic activation of action tendencies and physiological responses. Because self-reports of affect are also known to be biased by various factors, including deficits in introspection or impression management strategies, an indirect measure, the Implicit Positive and Negative Affect Test (IPANAT), was developed to assess implicit affect and to circumvent these difficulties. In this review, findings from neurobiological and clinical studies administering the IPANAT are revised, we focus on the link between implicit affect and psychophysiological reactions to affective stimuli and stressors. Specifically, implicit affect as measured by the IPANAT was found to predict cardiovascular, endocrine, and functional neuroimaging correlates of stress or fear beyond explicit affect. The present evidence strongly suggests the usage of implicit affect measures in future research on stress and psychopathology.

Addressing Maternal Depression, Substance Use, and Intimate Partner Violence in Home Visiting: a Quasi-Experimental Pilot Test of a Screen-and-Refer Approach.

This quasi-experimental pilot study describes preliminary impacts of the "Home Visitation Enhancing Linkages Project (HELP)," a pragmatic screen-and-refer approach for promoting identification of and linkage to treatment for maternal depression (MD), substance use (SU), and intimate partner violence (IPV) within early childhood home visiting. HELP includes screening for MD, SU, and IPV followed by a menu of motivational interviewing and case management interventions aimed at linking clients to treatment, designed for delivery within routine home visiting. HELP was piloted within four counties of a statewide home visiting system that were implementing Healthy Families America. HELP clients (N = 394) were compared to clients in five demographically matched counties that received usual Healthy Families services (N = 771) on whether their home visitors (1) identified MD, SU, and IPV risk; (2) discussed MD, SU, and IPV during home visits; and (3) made referrals for MD, SU, and IPV. All data were extracted from the program's management information system. A significant impact of HELP was found on discussion of risk in home visits for all three risk domains with large effect sizes (MD OR = 4.08; SU OR = 15.94; IPV OR = 9.35). HELP had no impact on risk identification and minimal impact on referral. Findings provide preliminary support for HELP as a way of improving discussion of client behavioral health risks during home visits, an important first step toward better meeting these needs within home visiting. However, more intensive intervention is likely needed to impact risk identification and referral outcomes.

Candidiasis sistémica en pacientes críticos, factores predictores de riesgo / Systemic candidiasis in critical patients: risk predictors

Candida sp. constituye el microorganismo más frecuentemente implicado en las infecciones por hongos en pacientes críticamente enfermos. La candidemia es la forma más común de candidiasis invasiva, ingresando al torrente sanguíneo por el tracto gastrointestinal y la piel. A nivel mundial la candidemia se destaca como una de las principales causas de morbilidad con aumentos significativos en la incidencia y prevalencia en los últimos años. Además, eleva los costos de la atención hospitalaria. Aunque diversos estudios demuestran que el inicio temprano del tratamiento antifúngico mejora el pronóstico de los pacientes, se tienen dificultades con las pruebas diagnósticas existentes, debido a que no tienen un nivel adecuado de sensibilidad y un óptimo rendimiento. Por tal razón, en la actualidad se vienen utilizando diversos índices clínicos predictores de candidiasis invasiva como Ostrosky, Candida Score, Escala de Pittet, entre otros, los cuales tienen un alto valor predictivo negativo que permite reconocer los pacientes que no se benefician de un inicio temprano de un tratamiento antifúngico mientras se confirma el diagnóstico por laboratorio. La terapia antifúngica disponible para el tratamiento de las candidemias en UCI está compuesta básicamente por tres grupos de medicamentos, los azoles, los polienos y las equinocandinas. A pesar de la validación de los índices predictores de candidiasis invasiva en otros países, se desconoce cuál de estos sería el más efectivo para predecir esta patología en la región

Candida sp. is the microorganism most frequently involved in fungal infections in critically ill patients. Candidemia is the most common form of invasive candidiasis entering the bloodstream from the gastrointestinal tract and skin. Worldwide candidemia stands out as one of the leading causes of morbidity with significant increases in its incidence and prevalence in recent years. In addition, it raises the costs of hospital care. Although several studies show that early initiation of antifungal treatment improves patients' prognosis, there are difficulties with existing diagnostic tests, because they do not have an adequate level of sensitivity and optimum performance. For this reason, various clinical indices are currently being used as predictors of invasive candidiasis, such as Ostrosky Candida Score, Candida Score, Pittet Candida Colonization Index, among others, which have a high negative predictive value that allows to recognize patients who do not benefit from an early initiation of an antifungal treatment while the diagnosis is confirmed by laboratory. Antifungal therapy available for the treatment of candidemia in the ICU consists basically of three groups of drugs: azoles, polyenes and echinocandins. Despite the validation of predictors of invasive candidiasis in other countries, it is still unknown which of these would be the most effective for predicting this disease in the region

Development and implementation of a screen-and-refer approach to addressing maternal depression, substance use, and intimate partner violence in home visiting clients.

Perinatal maternal depression (MD), substance use (SU), and intimate partner violence (IPV) are critical public health concerns with significant negative impacts on child development. Bolstering the capacity of home visiting (HV) programs to address these significant risk factors has potential to improve child and family outcomes. This study presents a description and mixed-methods feasibility evaluation of the "Home Visitation Enhancing Linkages Project (HELP)," a screen-and-refer approach to addressing MD, SU, and IPV within HV aimed at improving risk identification and linkage to treatment among HV clients. HELP was a three-phase intervention that included three evidence-based interventions: screening, motivational interviewing (MI), and case management (CM). This study presents quantitative fidelity data from 21 home visitors reporting on 116 clients in 4 HV programs, as well as qualitative data from structured interviews with 14 home visitors. Nearly all clients were screened and 22% screened positive on at least one risk domain. Rates of MI and CM implementation were lower than expected, however home visitors implemented general supportive interventions at high rates. Home visitor interviews revealed the following factors that may have impacted HELP implementation: client disclosure of risk, barriers to treatment access, systems integration, home visitor role perception, and integration of HELP into the broader HV curriculum. Implications of study findings for the design of future attempts to address maternal risk within HV are discussed.

Perfil neuropsicológico de paciente adulto joven con síndrome Z / Neuropsychological profile of young adult patient with Z syndrome

Esta investigación tiene como objetivo establecer el perfil neuropsicológico de una paciente quien padece Síndrome de apnea obstructiva junto con Síndrome metabólico, esta interacción la cual actualmente se conoce como Síndrome Z. Mediante un estudio descriptivo de caso único, teniendo en cuenta una batería neuropsicológica previamente determinada, se caracteriza el desempeño cognitivo de un paciente masculino de 34 años con el diagnóstico mencionado. Los datos fueron analizados con la baremación correspondiente a cada prueba, encontrando dificultades cognitivas a nivel de función ejecutiva, especialmente en funciones de la corteza prefrontal dorsolateral. Como conclusión se establece que el síndrome Z se asocia a un trastorno neurocognitivo menor en un adulto joven.

This research aims to establish the neuropsychological profile of a patient suffering from obstructive apnea syndrome along with metabolic syndrome, this interaction is currently known as Z Syndrome. A descriptive study of a single case, considering a neuropsychological battery previously determined, the cognitive performance of a 34-year-old male patient with the mentioned diagnosis is characterized. The data was analyzed with the corresponding standard to each test, finding cognitive difficulties at the level of executive function, especially in functions of the dorsolateral prefrontal cortex. In conclusion, it is established that Z syndrome is associated with a minor neurocognitive disorder in a young adult.

The role of DOC-2/DAB2 in modulating androgen receptor-mediated cell growth via the nongenomic c-Src-mediated pathway in normal prostatic epithelium and cancer.

Prostate cancer is initially responsive to androgen ablation, but prostate cancer tumors invariably progress to an androgen-independent state that is ultimately lethal. The onset of the androgen-independent prostate cancer is often associated with up-regulation of the androgen receptor that can cause antagonists to exhibit agonistic activity, which could lead to the failure of androgen ablation therapy. We describe a unique protein-DOC-2/DAB2 (differentially expressed in ovarian cancer-2/disabled 2)-that antagonizes androgen receptor-mediated cell growth in prostate cancer cells via interaction with c-Src protein. This interaction causes inactivation of Erk and Akt proteins critical for proliferation and survival of prostate cancer cells. However, DOC-2/DAB2 does not change the capacity of androgen receptor to regulate the transcription of androgen-responsive reporter genes, indicating that DOC-2/DAB2 selectively inhibits androgen receptor-mediated cell growth in androgen-independent prostate cancer by disrupting the androgen receptor/c-Src complex. In normal prostatic epithelia, DOC-2/DAB2 protein levels are more abundant than androgen receptor protein levels and reduced endogenous DOC-2/DAB2 protein levels in these cells by DOC-2/DAB2 RNA interference result in enhancing androgen receptor-mediated cell growth. We conclude that DOC-2/DAB2 can modulate androgen receptor-mediated cell growth in both normal and malignant prostatic epithelial cells and the outcome of this study could evolve into a new therapeutic strategy of prostate cancer.

Synergistic induction of DOC-2/DAB2 gene expression in transitional cell carcinoma in the presence of GATA6 and histone deacetylase inhibitor.

The down-regulation of DOC-2/DAB2 gene, which encodes a unique phosphoprotein modulating signal pathways elicited by exogenous stimuli, is often associated with several cancer types; however, the underlying mechanism is still unknown. Dramatically different expression levels of DOC-2/DAB2 mRNA and protein are observed among several human transitional cell carcinoma (TCC) cell lines, suggesting that transcriptional regulation may play a role in these cells. In this study, we have shown that the histone acetylation status associated with the 5' upstream regulatory sequence of DOC-2/DAB2 gene is one of the key determinants for its gene expression. In addition, GATA6 but not other GATA family members, such as GATA2 and GATA4, can specifically induce DOC-2/DAB2 promoter activity, although GATA transcription factors share a very similar DNA-binding sequence. We also show that increased histone acetylation and the presence of GATA6 have a synergistic effect on DOC-2/DAB2 promoter activity, which results in the elevation of DOC-2/DAB2 protein expression. Thus, we conclude that transcriptional regulation of DOC-2/DAB2 gene in human TCC is determined by histone acetylation and a specific transcription factor (i.e., GATA6), which underlie the reduced DOC-2/DAB2 protein expression in TCC cells.

Urine detection of survivin is a sensitive marker for the noninvasive diagnosis of bladder cancer.

PURPOSE: In a preliminary study urine detection of survivin, an integrator of cell death and mitosis, accurately detected bladder cancer. The objectives of this study were to confirm these findings in a large cohort of subjects undergoing cystoscopy, to assess the diagnostic performance of urine survivin and to test whether evaluation of urine survivin adds independent value to urine NMP22 (Matritech, Cambridge, Massachusetts) and cytology for the detection of bladder cancer. MATERIALS AND METHODS: Urine survivin was measured using a Bio-Dot microfiltration detection system (Bio-Rad, Hercules, California) in voided urine specimens collected before cystoscopy in 117 cases and 92 controls. Bladder washout samples for cytology were collected in 174 subjects. Urine levels of NMP22 were measured using a commercially available enzyme-linked immunosorbent assay. RESULTS: Higher levels of urine survivin were associated with an increased risk of bladder cancer (p <0.001) and tumors of higher grade (p = 0.037), but not with invasive stage, after adjustment for the effects of urine cytology, NMP22 and age. The sensitivity, specificity, and positive and negative predictive values of survivin for the diagnosis of bladder cancer (64%, 93%, 92% and 67%, respectively), are superior to those of NMP22 and cytology. Survivin had the highest specificity and positive predictive value for the detection of bladder cancer across each tumor stage and grade. CONCLUSIONS: Urine survivin was a strong, independent predictor of the presence of bladder cancer and higher tumor grade. Urine detection of survivin is an accurate diagnostic test for bladder cancer that retains its efficiency regardless of cancer stage and grade.