Women's Knowledge of Genomic Testing and Precision Medicine in Breast Cancer Treatment Decision-Making.

PURPOSE: To understand awareness of genetic and genomic testing, as well as decision-making, in women diagnosed with breast cancer. PARTICIPANTS & SETTING: 29 African American/Black and Latina/Hispanic women diagnosed with breast cancer. METHODOLOGIC APPROACH: A semistructured interview guide was used in focus groups conducted via videoconference. Transcripts were analyzed using thematic analysis. FINDINGS: Many of the women understood the concept of genetic testing to identify the BRCA1/BRCA2 variant, but none of them were aware of genomic testing and its implications for personalized medicine. Participants discussed provider and patient roles in treatment decision-making, identifying roles that the physician might play in treatment planning, from primary decision-maker to collaborator. IMPLICATIONS FOR NURSING: As the number of precision cancer treatments expands, patients must be able to comprehend the information provided to make informed decisions about their treatment. Providers should do a better job of explaining potential treatments so that patients feel they are part of the decision-making process. Addressing gaps in treatment access and uptake requires providers to prioritize patient engagement and understanding.

A Participatory Approach to Identifying Gaps in and Recommendations for Sexually Transmitted Infection and Preexposure Prophylaxis Clinical Services in Pierce County, Washington.

BACKGROUND: Pierce County, Washington, has a high burden of sexually transmitted infections (STIs) relative to Washington State and the United States. We used a participatory approach to identify gaps in STI and preexposure prophylaxis (PrEP) service provision in Pierce County and generate recommendations to address these gaps. METHODS: In collaboration with the Tacoma-Pierce County Health Department (TPCHD), we conducted 14 key informant interviews with local STI/PrEP providers from varied clinical settings. Using rapid qualitative analysis, we identified key gaps and strengths in service provision. Local, state, and national HIV/STI subject matter experts (SMEs) prioritized the gaps and recommendations to address them via an online survey. RESULTS: The primary 6 gaps ranked by SMEs (N = 32) in order of importance included the following: (1) inadequate availability of STI and PrEP services, (2) lack of awareness of STI and PrEP services, (3) need for free/low cost STI and PrEP care, (4) need for stronger relationships among providers and TPCHD, (5) reduced accessibility related to geographically distributed population and centralized services, and (6) frequent referrals pose a service barrier. Subject matter experts prioritized recommendations for each gap as follows: (1) create an STI specialty clinic, (2) implement an STI/PrEP service availability outreach campaign, (3) strengthen referral relationships between TPCHD and free/low-cost providers, (4) develop a provider support network, (5) create a mobile STI clinic, and (6) develop an STI specialty clinic. CONCLUSIONS: Sexually transmitted infection specialty clinics were prioritized by SMEs to improve access to STI and PrEP care in Pierce County, and to serve as a resource for local providers.

Mammography screening beliefs and barriers through the lens of Black women during the COVID-19 pandemic.

BACKGROUND: Mammography is an effective screening tool that leads to decreased breast cancer mortality, yet minority women continue to experience barriers. The coronavirus disease 2019 (COVID-19) pandemic has been proven to have negatively affected minority communities, yet its effect on mammography screening habits in Black women is uncertain. The purpose of this study was to evaluate breast cancer mammography screening habits and barriers for Black women in two northeast communities amid the COVID-19 pandemic. METHODS: The study participants were Black women aged 40 years or older who were recruited from community outreach initiatives. Study coordinators conducted telephone surveys to determine mammography screening behaviors, perceptions, and psychosocial factors. RESULTS: Two hundred seventy-seven surveys were completed. Two hundred fifty-six patients who reported ever having a mammogram became the study population of interest. One hundred seventy-four of these patients (68%) reported having a mammogram within the past year (nondelayed), and 82 (32%) had a mammogram more than a year ago (delayed). Only thirty-one of the delayed participants (37.8%) had private insurance. There was a significant difference in the mean score for mammography screening perceived barriers for nondelayed participants (mean = 9.9, standard deviation [SD] = 3.6) versus delayed participants (mean = 11.2, SD = 4.3, p = .03). There was also a significant difference in the mean score when they were asked, "How likely is it that 'other health problems would keep you from having a mammogram'?" (p = .002). CONCLUSIONS: Barriers to mammography screening for Black women during the COVID-19 era include insurance, competing health issues, and perceptions of screening. Community outreach efforts should concentrate on building trust and collaborating with organizations to improve screening despite the COVID-19 pandemic.

Caracterización de pacientes con infarto agudo de miocardio atendidos en el Hospital General Universitario Dr. Gustavo Aldereguía Lima

Fundamento: el infarto agudo de miocardio con elevación del segmento ST impone un gran desafío a los sistemas de salud, por tanto, su diagnóstico y manejo son importantes. Objetivo: determinar las principales características clínico-epidemiológicas de pacientes con diagnóstico de infarto agudo de miocardio con elevación del segmento ST. Métodos: se realizó un estudio descriptivo y transversal sobre una serie de pacientes atendidos en el Hospital General Universitario Dr. Gustavo Aldereguía Lima de Cienfuegos, en el periodo de enero a junio de 2021. El universo estuvo constituido por 77 pacientes. Se estudiaron variables como: edad, sexo, color de la piel, procedencia, comorbilidades, hábitos tóxicos, manifestaciones clínicas, trombolisis, lugar donde se trombolizaron, causas de no trombolisis, topografía del infarto agudo de miocardio, estado al egreso, complicaciones del infarto y del tratamiento trombolítico. Para el procesamiento y análisis de la información se creó una base de datos en el paquete estadístico SPSS versión 21.0 que permitió el cálculo de las frecuencias absolutas y los porcentajes. Resultados: la media de edad fue 66,08 (±9,43). Hubo un predominio del sexo masculino (64,7 %); el 59,7 % de los pacientes fueron trombolizados; el dolor torácico típico fue la principal manifestación clínica con un 71,4 %; fallecieron 12 pacientes, de ellos el 10,4 % no recibió tratamiento trombolítico. Conclusiones: el principal motivo de consulta sigue siendo el dolor torácico. La edad y las comorbilidades son factores de riesgo a tener en cuenta a la hora de prevenir esta entidad. La trombolisis es una medida terapéutica que tiene repercusión directa en el estado al egreso de los pacientes, este procedimiento se realiza en su mayoría en el hospital.

Background: ST-segment elevation acute myocardial infarction poses a great challenge to health systems, therefore its diagnosis and management are important. Objective: to determine the main clinical-epidemiological characteristics of patients diagnosed with ST-segment elevation acute myocardial infarction. Methods: a descriptive and cross-sectional study was carried out on a series of patients treated at the Dr. Gustavo Aldereguía Lima University General Hospital in Cienfuegos, from January to June 2021. The universe consisted of 77 patients. Variables such as: age, sex, skin color, origin, comorbidities, toxic habits, clinical manifestations, thrombolysis, place where they were thrombolyzed, causes of non-thrombolysis, topography of acute myocardial infarction, discharge status, infarction complications and of thrombolytic treatment. For the processing and analysis of the information, a database was created in the statistical package SPSS version 21.0 that allowed the calculation of the absolute frequencies and the percentages. Results: the mean age was 66.08 (±9.43). There was a predominance of the male sex (64.7 %); 59.7 % of the patients were thrombolyzed; typical chest pain was the main clinical manifestation with 71.4 %; 12 patients died, of which 10.4 % did not receive thrombolytic treatment. Conclusions: the main reason for consultation continues to be chest pain. Age and comorbidities are risk factors to take into account when preventing this entity. Thrombolysis is a therapeutic measure that has a direct impact on the state at discharge of patients, this procedure is performed mostly in the hospital.

Labor de estudiantes de Ciencias Médicas en el enfrentamiento a la COVID-19 en Cienfuegos

Fundamento: las tareas de impacto realizadas por estudiantes de ciencias médicas constituyeron un factor indispensable en el enfrentamiento a la COVID-19. Objetivo: caracterizar la labor de los estudiantes de las ciencias médicas en el enfrentamiento a la COVID-19 en Cienfuegos. Métodos: estudio observacional, descriptivo y transversal en el período de febrero a septiembre de 2021. El universo estuvo constituido por 1815 estudiantes de Estomatología y Medicina que se encontraban realizando labores de enfrentamiento a la COVID-19. Se trabajó con todo el universo. Fueron analizadas variables como municipio de procedencia, miembros del Movimiento de Alumnos Ayudantes, tarea de impacto, lugar donde se desempeñaron y realización de múltiples labores. Se emplearon técnicas de estadística descriptiva. Resultados: la edad promedio fue de 20,6 años y predominó el sexo femenino (70 %). La carrera de medicina fue la más representada (96,0 %). El municipio Cienfuegos contó con la mayor participación estudiantil (49,4 %). La totalidad de estudiantes se incorporó al menos a una tarea de impacto. El 99,8 % contribuyó a la pesquisa activa en la comunidad. La tarea de mayor impacto para los estudiantes de primer año fue la pesquisa (90 %), mientras que la vacunación lo fue en los restantes años académicos. Conclusiones: los estudiantes de ciencias médicas de Cienfuegos se sumaron a disímiles tareas de impacto en el enfrentamiento a la COVID-19, que contribuyen a su formación integral y muestran el sentido del deber que caracteriza al personal sanitario formado en el país.

Background: the impact tasks carried out by medical sciences students constituted an essential factor in the confrontation with COVID-19. Objective: to characterize the medical science students work in the confrontation with COVID-19 in Cienfuegos. Methods: observational, descriptive and cross-sectional study from February to September 2021. The universe consisted of 1815 Dentistry and Medicine students who were fighting against COVID-19. The whole universe was studied. Variables such as the municipality of origin, members of the Student Helpers Movement, impact task, place where they worked and multiple tasks were also analyzed. Descriptive statistical techniques were used. Results: the average age was 20.6 years and the female sex predominated (70%). The medical career was the most represented (96.0%). The Cienfuegos municipality had the highest student participation (49.4%). All students were incorporated into at least one impact task. 99.8% contributed to the active research in the community. The task with the greatest impact for first-year students was research (90%), while vaccination was in the remaining academic years. Conclusions: medical science students from Cienfuegos joined different impact tasks in the fight against COVID-19, which contribute to their comprehensive training and show the sense of duty that characterizes health personnel trained in the country.

Sister, Give Me Your Hand: a Qualitative Focus Group Study on Beliefs and Barriers to Mammography Screening in Black Women During the COVID-19 Era.

AIMS/PURPOSE: To evaluate current day challenges and beliefs about breast cancer screening for Black women in two diverse northeast communities in the midst of the COVID-19 pandemic. BACKGROUND: Breast cancer is the second leading cause of cancer-related death in women in the USA. Although Black women are less likely to be diagnosed with breast cancer, they suffer a higher mortality. Early detection of breast cancer can be accomplished through routine screening mammography, yet the effect of the COVID-19 pandemic on mammography screening barriers and perception in minority communities is uncertain. METHODS: Five focus group interviews were conducted as the first phase of a mixed method study across two heterogeneously diverse locations, Camden, New Jersey, and Brooklyn, New York. RESULTS: Thirty-three women participated in this study; sixteen women were recruited at the New Jersey location and seventeen at the New York location. Only two thirds of the women stated that they had received a mammogram within the last 2 years. The major themes were binary: I get screened or I do not get screened. Subthemes were categorized as patient related or system related. CONCLUSIONS: Our findings on factors that affect breast cancer screening decisions during the COVID-19 era include barriers that are related to poverty and insurance status, as well as those that are related to medical mistrust and negative healthcare experiences. Community outreach efforts should concentrate on building trust, providing equitable digital access, and skillfully addressing breast health perceptions.

Intervenciones de prevención sobre el consumo de alcohol en jóvenes universitarios / Prevention interventions of alcohol consumption in young university students

Introducción: La ingesta de alcohol está condicionada por aspectos individuales y culturales. Objetivo: Identificar el efecto de intervenciones realizadas en el contexto latinoamericano sobre pautas de consumo o factores de riesgo asociados al consumo de alcohol en jóvenes universitarios. Materiales y métodos: Revisión sistemática a partir de la pregunta PICO, Se realizó búsqueda desde abril a agosto del 2020 en las bases de PubMed, CUIDEN, BVS, Scielo, Google Scholar y Repositorios Gubernamentales. Se utilizaron descriptores DeCS y MeSH, en español, inglés y portugués con los operadores AND y OR. Criterios de elegibilidad: estudios experimentales y cuasi experimentales publicados entre 2014 y 2020. Se obtuvieron 49 artículos, la lectura crítica permitió seleccionar 8 a los cuales se les aplicaron las escalas AMSTAR2, TREND y CONSORT quedando 6 artículos para análisis. Según la Resolución 008430/93, Artículo 10, se consideró como investigación sin riesgo. Resultados: Intervenciones unicomponente reportaron efectos sobre creencias conductuales, actitudes, conocimiento de la sustancia, rendimiento académico, menor frecuencia de consumo y no conducir bajo efectos del alcohol. Las intervenciones multicomponente disminuyen en 3.03% el riesgo de consumo y reportan percepción positiva respecto a la utilidad de las actividades desarrolladas, satisfacción de expectativas, satisfacción general, calidad de materiales empleados, asistencia y puntualidad. Discusión: Los estudios sugieren implementar nuevas intervenciones, estrategias y políticas en salud primaria para promover una transformación social, educativa y sanitaria que generen un impacto favorable para mitigar la problemática actual de consumo de alcohol en jóvenes universitarios. Conclusión: Esta revisión sistemática permitió sintetizar y valorar la evidencia disponible frente a intervenciones unicomponente y multicomponente realizadas en el contexto latinoamericano y del caribe que modifican positivamente factores de riesgo y pautas de consumo en jóvenes universitarios.

Introduction: Individual and cultural aspects condition alcohol intake. Objetive:To identify the effect of interventions conducted in Latin America on consumption patterns or associated risk factors for alcohol consumption among young university students. Materials and Methods:Systematic review based on a PICO question. A literature search was conducted from April to August 2020 in PubMed, CUIDEN, BVS, Scielo, Google Scholar, and Governmental Repositories. DeCS and MeSH descriptors in Spanish, English, and Portuguese were used with Boolean operators AND and OR. Eligibility criteria included experimental and quasi-experimental studies published between 2014 and 2020. Forty-nine articles were identified, and critical reading allowed the selection of 8 articles to which the AMSTAR2, TREND, and CONSORT appraisal tools were used, leaving 6 articles for analysis. In accordance with Article 10 of Resolution 008430/93, this was considered risk-free research. Results: Single-component interventions reported effects on behavioral beliefs, attitudes, knowledge of the substance, academic performance, lower frequency of drinking, and not driving under the influence of alcohol. Multicomponent interventions reduced consumption risk by 3.03% and reported positive perceptions regarding the usefulness of activities, expectations fulfillment, overall satisfaction, quality of materials used, attendance, and punctuality. Discussion:The studies suggest implementing new interventions, strategies and policies in primary health to promote a social, educational and health transformation that generate a favorable impact to mitigate the current problem of alcohol consumption in university students. Conclusions: This systematic review made it possible to synthesize and evaluate the available evidence on single- and multicomponent interventions in Latin America and the Caribbean that positively modify risk factors and consumption patterns in young university students.

Introdução: A ingestão de álcool é condicionada por aspectos individuais e culturais. Objetivo: Identificar o efeito de intervenções realizadas no contexto latino-americano sobre os padrões de consumo ou fatores de risco associados ao consumo de álcool em estudantes universitários. Materiais e métodos: Revisão sistemática com base na pergunta PICO, realizada de abril a agosto de 2020 nas bases de dados PubMed, CUIDEN, BVS, Scielo, Google Scholar e Government Repositories. Foram utilizados os descritores DeCS e MeSH, em espanhol, inglês e português com operadores AND e OR. Critérios de elegibilidade: estudos experimentais e quase-experimentais publicados entre 2014 e 2020. Obtiveram-se 49 artigos, a leitura crítica permitiu selecionar 8, aos quais foram aplicadas as escalas AMSTAR2, TREND e CONSORT, restando 6 artigos para análise. De acordo com a Resolução 008430/93, artigo 10, foi considerada pesquisa livre de risco. Resultados: Intervenções unicomponentes relataram efeitos sobre crenças comportamentais, atitudes, conhecimento da substância, desempenho acadêmico, menor frequência de consumo e não dirigir sob efeito de álcool. As intervenções multicomponentes reduzem o risco de consumo em 3,03% e relatam uma percepção positiva quanto à utilidade das atividades realizadas, satisfação das expectativas, satisfação geral, qualidade dos materiais utilizados, assiduidade e pontualidade. Discussão: Os estudos sugerem a implementação de novas intervenções, estratégias e políticas na atenção primária à saúde para promover uma transformação social, educacional e sanitária que gere impacto favorável para mitigar o problema atual do consumo de álcool em estudantes universitários. Conclusões: Esta revisão sistemática permitiu sintetizar e avaliar as evidências disponíveis sobre intervenções unicomponentes e multicomponentes realizadas no contexto latino-americano e caribenho que modificam positivamente os fatores de risco e os padrões de consumo em estudantes universitários.

Encapsulation of wild oregano, Plectranthus amboinicus (Lour.) Spreng, phenolic extract in baker's yeast for the postharvest control of anthracnose in papaya.

BACKGROUND: Anthracnose caused by Colletotrichum gloeosporioides is considered as a major postharvest disease affecting many fruits. This plant disease is traditionally managed with synthetic fungicides, which are generally toxic and are linked to pathogen resistance. Recently, microencapsulated bioactives have been developed as potential alternative strategies to these methods, while utilizing natural fungicides and other phytochemicals. Wild oregano, Plectranthus amboinicus (Lour.) Spreng, contains potent antimicrobial phenolics, but these compounds are volatile and relatively unstable, which limits their efficacy during application. Herein, a baker's yeast microencapsulation system was applied to improve the stability of wild oregano phenolic extract (WOPE) and enhance its antifungal activity against anthracnose. RESULTS: Encapsulation of WOPE in plasmolyzed yeast cells afforded a high encapsulation efficiency (93%) and yielded WOPE-loaded yeast microcapsules (WLYMs) with an average diameter of 2.65 µm. Storage stability studies showed WLYMs are stable for at least 4 months. A 24 -h in vitro release experiment showed that WLYMs had an initial burst release upon redispersion in water, followed by a controlled release to about 80% of the loaded WOPE. Upon application as a spray-type postharvest treatment for papaya, WLYMs exhibited a significantly improved mycelial inhibitory action against C. gloeosporioides and greatly reduced the anthracnose symptoms in papaya fruits. CONCLUSION: This study presented a yeast microencapsulation system that can effectively stabilize WOPE and enhance its antifungal activity, making this microparticle formulation a promising environmentally safe postharvest treatment option to combat anthracnose symptoms in papaya fruits. © 2022 Society of Chemical Industry.

Mental health problems among healthcare workers involved with the COVID-19 outbreak

Objective: The mental health problems and perceived needs of healthcare workers involved with coronavirus disease (COVID-19) may vary due to individual and contextual characteristics. The objective of this study was to evaluate healthcare workers' mental health problems during the common COVID-19 exposure scenario in Mexico, comparing those on the frontline with other healthcare workers according to gender and profession, determining the main risk factors for the most frequent mental health problems. Methods: A cross-sectional online study was conducted with a non-probabilistic sample of 5,938 Mexican healthcare workers who completed brief screening measures of mental health problems and ad hoc questions about sociodemographic professional characteristics, conditions related to increased risk of COVID-19 infection, life stressors during the COVID-19 emergency, and perceived need to cope with COVID-19. Results: The identified mental health problems were insomnia, depression, and posttraumatic stress disorder (PTSD), all of which were more frequent in frontline healthcare workers (52.1, 37.7, and 37.5%, respectively) and women (47.1, 33.0 %, and 16.3%, respectively). A lack of rest time was the main risk factor for insomnia (OR = 3.1, 95%CI 2.6-3.7, p ≤ 0.0001). Mourning the death of friends or loved ones due to COVID-19 was the main risk factor for depression (OR = 2.2, 95%CI 1.8-2.7, p ≤ 0.0001), and personal COVID-19 status was the main risk factor for PTSD (OR = 2.2, 95%CI 1.7-2.9, p ≤ 0.0001). Conclusion: The most frequent mental health problems during the common exposure scenario for COVID-19 in Mexico included the short-term psychological consequences of intense adversity. A comprehensive strategy for preventing mental health problems should focus on individuals with cumulative vulnerability and specific risk factors.

Caracterización de pacientes con Hepatitis C en el servicio de hemodiálisis. Cienfuegos 2019 / Characterization of patients with hepatients with hepatitis c in the hemodialysis service.Cienfuegos 2019

RESUMEN Fundamento: La infección por el virus de la Hepatitis C ha sido reconocida como problema de salud a nivel mundial. Objetivo: Determinar las características de los pacientes con Hepatitis C que reciben tratamiento en el servicio de hemodiálisis del Centro Especializado Ambulatorio de Cienfuegos, en el periodo de enero a agosto del 2019. Metodología Se realizó un estudio observacional, descriptivo, longitudinal retrospectivo con los 54 pacientes en hemodiálisis portadores de Hepatitis C. Las variables utilizadas fueron: edad, sexo, lugar de procedencia, tipo de acceso vascular y tiempo en tratamiento. Se utilizó como fuente de información la base de datos del Centro Provincial de Higiene, Epidemiología y Microbiología en Cienfuegos. Resultados: El mayor porcentaje de personas con Hepatitis C se concentró entre los 50 a 54 años; siendo la edad promedio 53 años, sobresalió el sexo masculino para un 84.93%, y predominó el municipio de Cienfuegos como lugar de residencia. En relación al tipo de acceso vascular, la fístula arterio -venosa aportó el 98.14%, mientras el tiempo de tratamiento que prevaleció fue de más de 3 años para un 77.8%. Conclusiones La Hepatitis C en el servicio de hemodiálisis mostró un comportamiento similar a lo descrito en la literatura.

ABSTRACT Background Infection by the hepatitis c virus has been recognized as a health problem worldwide. Objective: To determine the characteristics of patients with hepatitis C receiving treatment in the Hemodialysis Service of the Cienfuegos Specialized Outpatient Center from January 2019 to August 2019. Methodology An observational, descriptive, longitudinal retrospective study was carried out with the 54 Hemodialysis patients with Hepatitis C. The variables used were: age, sex, place of origin, type of vascular access and time in treatment. The database of the Provincial Center for Hygiene, Epidemiology and Microbiology in Cienfuegos was used as a source of information. Results The highest percentage of people with hepatitis C was concentrated between 50 to 54 years old; The average age being 53 years, the male sex stood out for the 84.93%, with the municipality of Cienfuegos predominating as the place of residence. Regarding the type of vascular access, the arterio-venous fistula contributed the 98.14%, while the treatment time that prevailed was more than 3 years for the 77.8%. Conclusions: Hepatitis C in the hemodialysis service showed a similar behavior as described in the literature.

Factores relevantes sobre el ensayo RT-PCR para la detección de SARS-CoV-2, virus causante del COVID-19 / Relevant factors about the RT-PCR assay for the detection of SARS-CoV-2, virus that causes COVID-19

La disponibilidad de la secuencia de SARS-CoV-2 desde enero de 2020, permitió la implementación de ensayos de reacción en cadena de la polimerasa con transcripción inversa en tiempo real para la detección de este virus. Diversos tipos de muestra, reactivos y condiciones han sido estandarizados en diferentes países para utilizar este ensayo como prueba confirmativa de pacientes con COVID-19, siguiendo las indicaciones establecidas por la OMS en virtud de su alta sensibilidad y especificidad. Las condiciones generales para obtener resultados confiables de su aplicación implican detalles como la obtención de ácidos nucleicos en cantidad y pureza adecuadas de muestras que indiquen inequívocamente la presencia del virus en el paciente, incluso en etapas tempranas de la infección. El presente artículo presenta técnicas y procedimientos empleados por diferentes protocolos disponibles para la detección de SARS-CoV-2 mediante ensayos RT-PCR, efectuando comparaciones de parámetros de desempeño que permiten reconocer estrategias que pueden ser utilizadas en la mejora de este tipo de pruebas diagnósticas

The availability of the SARS-CoV-2 sequence since January 2020, allowed the implementation of real-time reverse transcription polymerase chain reaction assays for the detection of this virus. Various types of samples, reagents and conditions have been standardized in different countries to use this assay as a confirmatory test for patients with COVID-19, following the indications established by the WHO due to its high sensitivity and specificity. The general conditions for obtaining reliable results from its application involve details such as obtaining nucleic acids in adequate quantity and purity from samples that unequivocally indicate the presence of the virus in the patient, even in the early stages of infection. This article presents techniques and procedures used by different protocols available for the detection of SARS-CoV-2 by means of RT-PCR tests, making comparisons of performance parameters that allow to recognize strategies that can be used in the improvement of this type of diagnostic tests

Mental Health Problems among COVID-19 Frontline Healthcare Workers and the Other Country-Level Epidemics: The Case of Mexico.

COVID-19 frontline healthcare workers (FHCW) are struggling to cope with challenges that threaten their wellbeing. We examine the frequency and predictors of the most frequent mental health problems (MHP) among FHCW during the first COVID-19 peak in Mexico, one of the most severely affected countries in terms of FHCW's COVID-19 mortality. A cross-sectional survey was conducted between May 8 and August 18, 2020. A total of 47.5% of the sample (n = 2218) were FHCW. The most frequent MHP were insomnia, depression, posttraumatic stress symptoms, and health anxiety/somatization (whole sample: 45.7, 37.4, 33.9, and 21.3%; FHCW: 52.4, 43.4, 40.3 and 26.1, respectively). As compared to during the initial COVID-19 phase, depression and health anxiety/somatization symptoms as well as experiences of grieving due to COVID-19, personal COVID-19 status, and having relatives and close friends with COVID-19 were more frequent during the COVID-19 peak. Obesity, domestic violence, personal COVID-19 status, and grieving because of COVID-19 were included in regression models for main FHCW's MHP during the COVID-19 peak. In conclusion, measures to decrease other country-level epidemics contributing to the likelihood of COVID-19 complications (obesity) and MHP (domestic violence) as well as FHCW´s probability of COVID-19 infection could safeguard not only their physical but also mental health.

The Impact of Delays in Low-Income Women's Breast Cancer Experiences.

BACKGROUND: Low-income, underinsured and uninsured women are less likely to be diagnosed via mammogram and more often diagnosed at later stages, with a resultant negative impact on survival. The New Jersey Cancer Education and Early Detection Program provides access to cancer screening services for low-income, underinsured and uninsured individuals. This program was recently evaluated, and it was found that enrollees were more likely to be diagnosed at later stages than nonenrollees, which may be related to delays in diagnosis and treatment OBJECTIVE: The aim of this study was to determine if there were delays in diagnosis and treatment for program enrollees and, if so, what were the causes of these delays. METHODS: A qualitative methodology was used incorporating in-depth interviews with 20 women diagnosed with breast cancer through the New Jersey Cancer Education and Early Detection Program. Qualitative content analysis was used for data analysis. RESULTS: Three themes emerged: poor access to healthcare, lack of knowledge, and sense of spirituality. Nineteen of 20 women experienced delays in care; 9 were diagnosed with late stage (III or IV) disease. CONCLUSIONS: While the lack of insurance was a factor, fear, family needs, and a tendency to not prioritize their own health were additional reasons for delays in diagnosis and treatment. IMPLICATIONS FOR PRACTICE: Programs such as this are integral to the care of low-income, uninsured individuals. However, such programs are not sufficient to meet the needs of low-income women. The lack of a usual source of care is likely to be a factor in the delays these women experienced.

Mental health problems among healthcare workers involved with the COVID-19 outbreak.

OBJECTIVE: The mental health problems and perceived needs of healthcare workers involved with coronavirus disease (COVID-19) may vary due to individual and contextual characteristics. The objective of this study was to evaluate healthcare workers' mental health problems during the common COVID-19 exposure scenario in Mexico, comparing those on the frontline with other healthcare workers according to gender and profession, determining the main risk factors for the most frequent mental health problems. METHODS: A cross-sectional online study was conducted with a non-probabilistic sample of 5,938 Mexican healthcare workers who completed brief screening measures of mental health problems and ad hoc questions about sociodemographic professional characteristics, conditions related to increased risk of COVID-19 infection, life stressors during the COVID-19 emergency, and perceived need to cope with COVID-19. RESULTS: The identified mental health problems were insomnia, depression, and posttraumatic stress disorder (PTSD), all of which were more frequent in frontline healthcare workers (52.1, 37.7, and 37.5%, respectively) and women (47.1, 33.0 %, and 16.3%, respectively). A lack of rest time was the main risk factor for insomnia (OR = 3.1, 95%CI 2.6-3.7, p ≤ 0.0001). Mourning the death of friends or loved ones due to COVID-19 was the main risk factor for depression (OR = 2.2, 95%CI 1.8-2.7, p ≤ 0.0001), and personal COVID-19 status was the main risk factor for PTSD (OR = 2.2, 95%CI 1.7-2.9, p ≤ 0.0001). CONCLUSION: The most frequent mental health problems during the common exposure scenario for COVID-19 in Mexico included the short-term psychological consequences of intense adversity. A comprehensive strategy for preventing mental health problems should focus on individuals with cumulative vulnerability and specific risk factors.

Task Shifting for Initiation and Monitoring of Antiretroviral Therapy for HIV-Infected Adults in Uganda: The SHARE Trial.

BACKGROUND: With countries moving toward the World Health Organization's "Treat All" recommendation, there is a need to initiate more HIV-infected persons into antiretroviral therapy (ART). In resource-limited settings, task shifting is 1 approach that can address clinician shortages. SETTING: Uganda. METHODS: We conducted a randomized controlled trial to test if nurse-initiated and monitored ART (NIMART) is noninferior to clinician-initiated and monitored ART in HIV-infected adults in Uganda. Study participants were HIV-infected, ART-naive, and clinically stable adults. The primary outcome was a composite end point of any of the following: all-cause mortality, virological failure, toxicity, and loss to follow-up at 12 months post-ART initiation. RESULTS: Over half of the study cohort (1,760) was women (54.9%). The mean age was 35.1 years (SD 9.51). Five hundred thirty-three (31.6%) participants experienced the composite end point. At 12 months post-ART initiation, nurse-initiated and monitored ART was noninferior to clinician-initiated and monitored ART. The intention-to-treat site-adjusted risk differences for the composite end point were -4.1 [97.5% confidence interval (CI): = -9.8 to 0.2] with complete case analysis and -3.4 (97.5% CI: = -9.1 to 2.5) with multiple imputation analysis. Per-protocol site-adjusted risk differences were -3.6 (97.5% CI: = -10.5 to 0.6) for complete case analysis and -3.1 (-8.8 to 2.8) for multiple imputation analysis. This difference was within hypothesized margins (6%) for noninferiority. CONCLUSIONS: Nurses were noninferior to clinicians for initiation and monitoring of ART. Task shifting to trained nurses is a viable means to increase access to ART. Future studies should evaluate NIMART for other groups (e.g., children, adolescents, and unstable patients).

A qualitative assessment of psycho-educational videos for frontline COVID-19 healthcare workers in Mexico / Evaluación cualitativa de videos psicoeducativos para personal de salud de primera línea ante el COVID-19 en México

Abstract Introduction Frontline COVID-19 healthcare workers (FLHCWs) are at a high-risk of suffering occupational stress- and trauma-related mental health problems, including burnout and compassion fatigue (B&CF). Given the time limitations (due to their heavy workloads) and need to minimize face-to-face interventions (in order to avoid contagions), psychological interventions for FHCWs should be as brief and remote as possible. Objective To evaluate the usability and clarity of evidence-based psycho-educational videos to prevent B&CF, to deal with uncooperative, hostile, and anxious patients and relatives, and to use personal protective equipment (PPE), from the perspective of Mexican FLHCWs. Method Based on a convenience sampling by intensity approach, videos were distributed requesting feedback based on specific questions through WhatsApp to FLHCWs. Field notes were used to triangulate the information. Results Content analysis of feedback from a final sample of 24 participants ‒75% women, 42 ± 8.4 years old‒ yielded three general thematic categories and seven subthemes: 1. content evaluation, which included three subthemes: utility, pertinence, and practicality; 2. dissemination and other needs, with two subcategories: willingness to share and receive more videos (other needs); and 3. format aspects, also comprising two subthemes: attractiveness and duration. All participants found the videos content very beneficial, relevant, and applicable to the workplace and even in their everyday personal and family life, and were willing to share them and to receive more videos on other issues, including strategies to manage problems related to isolation. Discussion and conclusion Escalation of this remote preventive intervention to other COVID-19 centers and future similar epidemics is recommended.

Resumen Introducción Los trabajadores de la salud de primera línea (TSPL) ante el COVID-19 presentan alto riesgo de desgaste profesional y fatiga por compasión (DP&FC). Tomando en cuenta sus limitaciones de tiempo y la necesidad de minimizar las intervenciones cara a cara, las intervenciones psicológicas para los TSPL deben ser tan breves y remotas como sea posible. Objetivo Evaluar la utilidad y claridad de videos psicoeducativos basados en evidencia para prevenir DP&FC, el manejo de pacientes y familiares no cooperativos, hostiles o ansiosos, y el uso de equipo de protección personal desde la perspectiva de los TSPL mexicanos. Método Los videos se distribuyeron a los TSPL por medio de WhatsApp, solicitándoles su opinión con base en preguntas específicas. Se utilizaron notas de campo para triangular esta información. Resultados El análisis de contenido de las retroalimentaciones recibidas por una muestra final de 24 participantes ‒75% mujeres, 42 ± 8.4 años‒ arrojó tres categorías temáticas y nueve subtemas: 1. evaluación de contenido, con tres subtemas: utilidad, pertinencia y practicidad, 2. difusión y otras necesidades, con dos subcategorías: disponibilidad tanto a compartir como a recibir más videos (otras necesidades), y 3. aspectos de forma, también con dos subtemas: atractivo y duración. La totalidad consideró los videos muy benéficos, relevantes y aplicables en el trabajo y su vida diaria personal y familiar; y reportó disposición a compartirlos y a recibir más material de este tipo. Discusión y conclusión Se recomienda el escalamiento de esta medida preventiva y remota a otros centros COVID-19 y en futuras epidemias similares.

Implementation and evaluation of a Project ECHO telementoring program for the Namibian HIV workforce.

BACKGROUND: The Namibian Ministry of Health and Social Services (MoHSS) piloted the first HIV Project ECHO (Extension for Community Health Outcomes) in Africa at 10 clinical sites between 2015 and 2016. Goals of Project ECHO implementation included strengthening clinical capacity, improving professional satisfaction, and reducing isolation while addressing HIV service challenges during decentralization of antiretroviral therapy. METHODS: MoHSS conducted a mixed-methods evaluation to assess the pilot. Methods included pre/post program assessments of healthcare worker knowledge, self-efficacy, and professional satisfaction; assessment of continuing professional development (CPD) credit acquisition; and focus group discussions and in-depth interviews. Analysis compared the differences between pre/post scores descriptively. Qualitative transcripts were analyzed to extract themes and representative quotes. RESULTS: Knowledge of clinical HIV improved 17.8% overall (95% confidence interval 12.2-23.5%) and 22.3% (95% confidence interval 13.2-31.5%) for nurses. Professional satisfaction increased 30 percentage points. Most participants experienced reduced professional isolation (66%) and improved CPD credit access (57%). Qualitative findings reinforced quantitative results. Following the pilot, the Namibia MoHSS Project ECHO expanded to over 40 clinical sites by May 2019 serving more than 140 000 people living with HIV. CONCLUSIONS: Similar to other Project ECHO evaluation results in the United States of America, Namibia's Project ECHO led to the development of ongoing virtual communities of practice. The evaluation demonstrated the ability of the Namibia HIV Project ECHO to improve healthcare worker knowledge and satisfaction and decrease professional isolation.

Necesidades de aprendizaje de los adolescentes en relación a las adicciones / Learning needs of adolescents in relation to addictions / Necessidades de aprendizagem dos adolescentes em relação aos vícios

RESUMEN La drogodependencia representa un problema mundial. Los adolescentes constituyen un grupo vulnerable. El desconocimiento en relación a las adicciones y la baja percepción del riesgo que tal conducta supone constituyen factores significativos entre los mecanismos psicosociales que determinan esta problemática. Con el objetivo de determinar el nivel de conocimiento de los adolescentes sobre las adicciones se realizó un estudio descriptivo en la población comprendida en este grupo etario del consultorio médico 22, del Policlínico Jimmy Hirzel, Bayamo, provincia Granma. El universo lo conformaron 217 adolescentes dispensarizados, la muestra la constituyeron los 93 adolescentes que cumplieron los criterios de selección. Se estudiaron las variables: sexo, edad, ocupación y nivel de conocimiento. Se aplicaron métodos teóricos, empíricos y estadísticos. Como resultados, predominó el grupo de estudiantes, con edades comprendidas entre 10 y 14 años, del sexo masculino. Al realizar la encuesta 83.8% de los adolescentes tenía conocimientos insuficientes; 83.9% desconocía el efecto depresor de las drogas, 73.2% consideró que el uso frecuente de cantidades moderadas de algún tipo de droga no es una manifestación de tal conducta, 63.4% omitió que la ingestión de alcohol facilita el consumo de otras sustancias y 73.2% no valoró el consumo de sustancias como enfermedad.

ABSTRACT Drug dependence represents a worldwide problem. Adolescents are a vulnerable group. The ignorance in relation to addictions and the low perception of the risk that such behavior supposes constitute significant factors among the psychosocial mechanisms that determine this problem. In order to determine the level of adolescents' knowledge about addictions, a descriptive study was carried out in the population included in this age group of the medical office 22, from the Jimmy Hirzel Polyclinic, Bayamo, Granma province. The universe was made up of 217 dispensed adolescents, the sample was made up of 93 adolescents who met the selection criteria. Variables were studied: sex, age, occupation and level of knowledge. Theoretical, empirical and statistical methods were applied. As a result, the group of students, aged between 10 and 14 years, of the male sex predominated. When carrying out the survey 83.8% of the adolescents had insufficient knowledge; 83.9% were unaware of the depressant effect of drugs, 73.2% considered that the frequent use of moderate amounts of some type of drug is not a manifestation of such behavior, 63.4% omitted that the ingestion of alcohol facilitates the consumption of other substances and 73.2% did not value substance use as disease.

RESUMO A dependência de drogas representa um problema mundial. Os adolescentes são um grupo vulnerável. O desconhecimento em relação aos vícios e a baixa percepção do risco que esse comportamento supõe constituem fatores significativos entre os mecanismos psicossociais que determinam esse problema. Para determinar o nível de conhecimento dos adolescentes sobre dependências, foi realizado um estudo descritivo na população incluída nessa faixa etária do consultório médico 22, da Policlínica Jimmy Hirzel, Bayamo, província de Granma. O universo foi composto por 217 adolescentes dispensados, a amostra foi composta por 93 adolescentes que atenderam aos critérios de seleção. As variáveis ​​estudadas foram: sexo, idade, ocupação e nível de conhecimento. Foram aplicados métodos teóricos, empíricos e estatísticos. Como resultado, predominou o grupo de estudantes, comidades entre 10 e 14 anos, do sexo masculino. Ao realizar a pesquisa, 83,8% dos adolescentes possuíam conhecimento insuficiente; 83,9% desconheciam o efeito depressivo das drogas, 73,2% consideravam que o uso frequente de quantidades moderadas de algum tipo de droga não é manifestação desse comportamento, 63,4% omitiam que a ingestão de álcool facilita o consumo de outras substâncias e 73,2% não valorizou o uso de substâncias como doença.

Necesidades de aprendizaje de los adolescentes en relación a las adicciones / Learning needs of adolescents in relation to addictins

La drogodependencia representa un problema mundial. Los adolescentes constituyen un grupo vulnerable. El desconocimiento en relación a las adicciones y la baja percepción del riesgo que tal conducta supone constituyen factores significativos entre los mecanismos psicosociales que determinan esta problemática. Con el objetivo de determinar el nivel de conocimiento de los adolescentes sobre las adicciones se realizó un estudio descriptivo en la población comprendida en este grupo etario del consultorio médico 22, del Policlínico Jimmy Hirzel, Bayamo, provincia Granma. El universo lo conformaron 217 adolescentes dispensarizados, la muestra la constituyeron los 93 adolescentes que cumplieron los criterios de selección. Se estudiaron las variables: sexo, edad, ocupación y nivel de conocimiento. Se aplicaron métodos teóricos, empíricos y estadísticos. Como resultados, predominó el grupo de estudiantes, con edades comprendidas entre 10 y 14 años, del sexo masculino. Al realizar la encuesta 83.8 por ciento de los adolescentes tenía conocimientos insuficientes; 83.9 por ciento desconocía el efecto depresor de las drogas, 73.2 por ciento consideró que el uso frecuente de cantidades moderadas de algún tipo de droga no es una manifestación de tal conducta, 63.4 por ciento omitió que la ingestión de alcohol facilita el consumo de otras sustancias y 73.2 por ciento no valoró el consumo de sustancias como enfermedad(AU)

Drug dependence represents a worldwide problem. Adolescents are a vulnerable group. The ignorance in relation to addictions and the low perception of the risk that such behavior supposes constitute significant factors among the psychosocial mechanisms that determine this problem. In order to determine the level of adolescents' knowledge about addictions, a descriptive study was carried out in the population included in this age group of the medical office 22, from the Jimmy Hirzel Polyclinic, Bayamo, Granma province. The universe was made up of 217 dispensed adolescents, the sample was made up of 93 adolescents who met the selection criteria. Variables were studied: sex, age, occupation and level of knowledge. Theoretical, empirical and statistical methods were applied. As a result, the group of students, aged between 10 and 14 years, of the male sex predominated. When carrying out the survey 83.8 percent of the adolescents had insufficient knowledge; 83.9 percent were unaware of the depressant effect of drugs, 73.2 percent considered that the frequent use of moderate amounts of some type of drug is not a manifestation of such behavior, 63.4 percent omitted that the ingestion of alcohol facilitates the consumption of other substances and 73.2 percent did not value substance use as disease(EU)

Características de los pacientes con enfermedad cerebrovascular. Consultorios Médicos 9, 10,11. Policlínico 13 de Marzo. Bayamo. Enero-Julio 2019 / Characteristics of patients with cerebrovascular disease. Medical Offices 9, 10, 11. Polyclinic March 13. Bayamo. January-July 2019 / Características dos pacientes com doença cerebrovascular. Consultórios médicos 9, 10,11. Policlínica 13 de março. Bayamo. Janeiro a julho de 2019

RESUMEN El cerebro es el órgano más sensible del cuerpo. Distinción que exige para su funcionamiento del aporte constante de oxígeno y nutrientes, pues son elementos que lo conservan vivo y activo. Con el objetivo de caracterizar a los pacientes con enfermedad cerebrovascular de los consultorios médicos de la familia 9, 10 y 11 del Policlínico 13 de Marzo en Bayamo, de Enero a Julio de 2019, se realizó un estudio descriptivo y retroprospectivo, de corte transversal de 17 pacientes con enfermedad cerebrovascular. Los datos primarios fueron extraídos de las historias clínicas y registros de los consultorios y plasmados en una planilla elaborada a los efectos y se realiza una base de datos en Excel Microsoft 2010. Entre las variables de interés figuraron edad, sexo, antecedentes personales, clasificación, área de salud y secuela. Al relacionar, según el sexo de los pacientes con enfermedad cerebrovascular, se apreció un predominio en el sexo femenino 9 (52,94 %) y el grupo etario más afectado fue el de 78-92(41.18%), entre los antecedentes personales asociados, se presentó en el 94.11% de los pacientes la hipertensión, el 76.47 % presentó el tipo isquémico. El 41,18% de los pacientes con enfermedad cerebrovascular pertenecen al área de salud del CMF 9. El 41,18% de los pacientes presentaron como secuela la hemiplejia derecha, ya sea sola o con otra afectación. Las características principales de los pacientes con ECV en su mayoría resultaron féminas mayores de 70 años, hipertensas, sufrieron el tipo de accidentes isquémico y tienen como secuelas hemiplejia derecha.

ABSTRACT The brain is the most sensitive organ in the body. Distinction that requires for its operation the constant supply of oxygen and nutrients, because they are elements that keep it alive and active. With the aim of characterizing patients with cerebrovascular disease in the medical offices of the family 9, 10 and 11 of Polyclinic 13 March in Bayamo, from January to July 2019, a descriptive and retrospective study was conducted, of cross-sectional of 17 patients with cerebrovascular disease. The primary data were extracted from the medical records and records of the practices and embossed in a form prepared for purpose and a database is made in Excel Microsoft 2010. Among the variables of interest were age, sex, personal history, classification, health area and sequel. In relation, depending on the sex of patients with cerebrovascular disease, a predominance in the female sex was appreciated 9 (52.94%) and the most affected age group was 78-92(41.18%), among the associated personal history, 94.11% of patients had hypertension, 76.47% had the ischemic type. 41.18% of patients with cerebrovascular disease belong to the health area of CMF 9. 41.18% of patients had right hemiplegia as a sequel, either alone or with another involvement. The main characteristics of CVD patients were mostly females over 70 years of age, hypertensive, suffered the type of ischemic accidents and have as right hemiplegia sequelae.

RESUMO O cérebro é o órgão mais sensível do corpo. Distinção que requer para sua operação o fornecimento constante de oxigênio e nutrientes, pois são elementos que o mantêm vivo e ativo. Com o objetivo de caracterizar pacientes com doença cerebrovascular nos consultórios médicos da família 9, 10 e 11 de Março, em Bayamo, de janeiro a julho de 2019, foi realizado um estudo descritivo e retrospectivo, de 17 pacientes com doença cerebrovascular. Os dados primários foram extraídos dos prontuários e registros das práticas e gravados em forma de forma preparada para o propósito e um banco de dados é feito no Excel Microsoft 2010. Entre as variáveis de interesse estavam idade, sexo, histórico pessoal, classificação, área de saúde e sequela. Em relação, dependendo do sexo de pacientes com doença cerebrovascular, a predominância no sexo feminino foi valorizada 9 (52,94%) e a faixa etária mais afetada foi 78-92 (41,18%), entre o histórico pessoal associado, 94,11% dos pacientes tinham hipertensão, 76,47% tinham o tipo isquêmico. 41,18% dos pacientes com doença cerebrovascular pertencem à área de saúde do CMF 9. 41,18% dos pacientes apresentavam hemiplegia certa como sequela, sozinhos ou com outro envolvimento. As principais características dos pacientes com DCV foram, em sua maioria, mulheres com mais de 70 anos, hipertensas, que sofreram o tipo de acidenteis e têm como sequelas hemiplegia direita.