Perspectives on the Implementation of Screening and Treatment for Depression and Alcohol Use Disorder in Primary Care in Colombia.

Depression and alcohol use disorder (AUD) greatly contribute to the burden of disease worldwide, and have large impact on Colombia's population. In this study, a qualitative analysis evaluates the implementation of a technology-supported model for screening, decision support, and digital therapy for depression and AUD in Colombian primary care clinics. Patient, provider, and administrator interviews were conducted, exploring attitudes towards depression and AUD, attitudes towards technology, and implementation successes and challenges. Researchers used qualitative methods to analyze interview themes. Despite stigma around depression and AUD, the model improved provider capacity to diagnose and manage patients, helped patients feel supported, and provided useful prevalence data for administrators. Challenges included limited provider time and questions about sustainability. The implementation facilitated the identification, diagnosis, and care of patients with depression and AUD. There is ongoing need to decrease stigma, create stronger networks of mental health professionals, and transition intervention ownership to the healthcare center.

Validation of the FAMACHA eye color chart for detecting clinical anemia in sheep and goats on farms in the southern United States.

Recent studies on sheep and goat farms in the southern United States indicate that multiple-anthelmintic resistance in Haemonchus contortus is becoming a severe problem. Though many factors are involved in the evolution of resistance, the proportion of the parasite population under drug selection is believed to be the single most important factor influencing how rapidly resistance develops. Therefore, where prevention of resistance is an important parallel goal of worm control, it is recommended to leave a portion of the animals untreated. Recently, a novel system called FAMACHA was developed in South Africa, which enables clinical identification of anemic sheep and goats. When H. contortus is the primary parasitic pathogen, this system can be applied on the farm level to reduce the number of treatments administered, thereby increasing the proportion of the worm population in refugia. Since most studies validating the FAMACHA method have been performed in South Africa, it is important that the method be tested in other regions before its use is broadly recommended. We performed a validation study of FAMACHA by testing the system in sheep (n = 847) and goats (n = 537) of various breeds and ages from 39 farms located in Arkansas, Georgia, Louisiana, Florida, and the US Virgin Islands. The color of the ocular conjunctiva of all animals were scored on a 1-5 scale using the FAMACHA card, and blood samples were collected from each animal for determination of packed cell volume (PCV). Fecal samples were also collected from a majority of the animals tested for performance of fecal egg counts (FEC). Correlations between PCV and eye scores, PCV and FEC, and FEC and eye scores were all highly significant for both sheep and goats (P < 0.001). Data for both FAMACHA scores and PCV were evaluated using two separate criteria for anemia: eye score values of 3, 4 and 5 or 4 and 5, and PCV values of < or =19 or < or =15 were considered anemic. Specificity was maximized when eye score values of 4 and 5 were considered anemic and PCV cut off for anemia was < or =19, but sensitivity was low. In contrast, sensitivity was 100% for both sheep and goats when eye score values of 3, 4 and 5 were considered anemic and PCV cut off was < or =15, but specificity was low. In both sheep and goats, predictive value of a negative was greater than 92% for all anemia and eye score categories, and was greater than 99% for both eye score categories when an anemia cutoff of < or =15 was used. Predictive value of a positive test was low under all criteria indicating that many non-anemic animals would be treated using this system. However, compared to conventional dosing practices where all animals are treated, a large proportion of animals would still be left untreated. These data indicate that the FAMACHA method is an extremely useful tool for identifying anemic sheep and goats in the southern US and US Virgin Islands. However, further studies are required to determine optimal strategies for incorporating FAMACHA-based selective treatment protocols into integrated nematode control programs.

Vulvovaginitis, the gonococcus, and child abuse - abstract

Records of 424 girls under 12 years of age, who presented consecutively to University Hospital of the West Indies with a history of vaginal discharge, were kept on an on-going basis in a separate register for one year from November, 1983. The vaginal swabs showed non-specific flora in 49 percent, N. gonorrhoea in 14 percent, S. pneumoniae in 8 percent, H. influenzae Type B in 5 percent, C. albicans in 3 percent, other organisms in 13 percent, and unknown or culture negative results in 5 percent. Of the 58 children with gonorrhoea, 52 percent were under 6 years of age. Information available on 60 percent of these revealed possible sexual contact in 36 percent. Forty per cent of these were reportedly incestuous (father, brother, uncle, cousin), 30 percent involved step-father or mother's consort, and 30 percent family friends or neighbours. These figures may be underestimates. This report documents the occurrence in this age group of S. pneumoniae (not previously reported), N. gonorrhoeae, C. albicans among near-pubertal girls, T. Vaginalis in the 2 to 10 year-olds, the hidden problem of intrafamilial child abuse, and condylomata acuminata as an unusual manifestation of child abuse. Attention is drawn to vulvovaginitis in the hope that a high index of suspicion and family investigations for child abuse, gonorrhoea and incest will be encouraged; that health education for parents and schools will include information specific to perineal hygiene and sexually transmitted diseases; and that the child population, affected as it is by the increasing incidence of adult gonorrhoea, will be included in programmes for the control of this disease. The authors acknowledge with thanks the valuable assistance of the staff of their respective Departments (AU)