How can youth involvement in public health conferences promote a tobacco-free generation? Lessons from the ECToH 2023's Youth Committee.

Young health advocates have the legitimate aspiration to be masters of their future and are increasingly contributing to public health research and practice worldwide, yet their potential to contribute to the documentation and communication of outputs from public health conferences has not been fully realised. This short communication highlights the Youth Committee of the 2023 European Conference on Tobacco or Health as an example of youth involvement in a major public health conference focused on tobacco control. The authors explore the benefits, practicalities and challenges of incorporating young professionals into conference workflow, including creativity, networking and engagement with broader public health challenges within their communities. This article emphasises the active participation of Youth Committees in public health fora as a model for future conferences and underscores a commitment to achieving a tobacco-free generation.

La prueba del VIH orientada por condiciones indicadoras: oportunidades perdidas para adelantar el diagnóstico de la infección en hombres que tienen sexo con hombres / Indicator condition based HIV testing: Missed opportunities for earlier diagnosis in men who have sex with men

INTRODUCCIÓN: Analizar los contactos con el sistema sanitario de una muestra de hombres seropositivos que tienen relaciones sexuales con otros hombres (HSH) sucedidos con anterioridad a su diagnóstico de infección por VIH e identificar posibles oportunidades perdidas (OP) de haber adelantado su diagnóstico. MÉTODOS: Entre 2012-2013 se realizó una encuesta online a HSH infectados por el VIH que fueron seleccionados, fundamentalmente, en páginas de contacto gays. Se analizaron los diagnosticados de infección por VIH en el periodo 2010-2013. Se consideró OP a los episodios previos al diagnóstico en los que se contactó con el sistema sanitario por alguna condición indicadora de infección por VIH y no se propuso la prueba. Se compararon las proporciones de OP según el tipo de condición indicadora, el servicio consultado y el conocimiento del profesional de que el paciente atendido era HSH. RESULTADOS: En total, 639 participantes (66% de 966) refirieron 1.145 episodios con alguna condición indicadora, identificándose la mayoría en atención primaria (n = 527; 46%). También es en este servicio donde se observó la mayor proporción de OP (63%). Aunque las ITS fue la condición indicadora con mayor número de OP (n = 124), el mayor porcentaje de OP se observó en las consultas por diarreas sin causa clara (69,8%). El porcentaje de OP cuando el médico conocía que el paciente era HSH se elevó al 40% frente al 70% cuando lo desconocía. CONCLUSIÓN: La mayoría de los HSH positivos para el VIH acudió a los servicios sanitarios antes de su diagnóstico por condiciones indicadoras de infección por VIH. Atención primaria fue el servicio más visitado y también donde se estarían perdiendo más oportunidades para indicar la prueba de VIH, incluso sabiendo que el paciente es HSH

INTRODUCTION: Contact with the healthcare system by a sample of seropositive men who have sex with men (MSM) prior to their HIV diagnosis are analysed, and missed opportunities (MO) for an earlier HIV diagnosis are identified. METHODOLOGY: Between 2012-2013, an online survey was conducted among HIV-positive MSM, mainly recruited from gay websites. Those who were diagnosed with HIV between 2010-2013 were analysed. MO were defined as episodes prior to the HIV diagnosis in which the healthcare system was contacted due to an indicator condition of HIV infection and the test was not suggested. The proportion of missed opportunities were compared according to the type of indicator condition, the department consulted and the healthcare professional's knowledge that the patient was MSM. RESULTS: Overall, 639 participants (66% of 966) reported 1,145 episodes with some indicator condition, the majority of these being identified in primary care (n = 527; 46%). The highest percentage of MOs is also observed in primary care (63%). Although the indicator condition with the highest number of MOs was STIs (n = 124), the highest percentage of MOs was observed in consultations due to diarrhoea with no known cause (69.8%). The percentage of MOs when the doctor knew that the patient was MSM was 40 vs. 70% when the doctor did not know. CONCLUSION: The majority of HIV-positive MSM analysed in this study went to healthcare services for HIV-infection indicator conditions prior to their HIV diagnosis. Primary care was the most-frequently-visited department and is also where the most opportunities were missed to perform an HIV test, even when it was known that the patient was a MSM

A new criterion for detection of radiculopathy based on motor evoked potentials and intraoperative nerve root monitoring.

OBJECTIVE: Our objective is to use the area of the motor evoked potential (MEP) as a diagnostic tool for intraoperative radicular injury. METHODS: We analyzed the intraoperative neurophysiological monitoring data and clinical outcomes of 203 patients treated for dorsolumbar spine deformity. The decrease in amplitude was compared with the reduction in the MEP area. RESULTS: In 11 cases, new intraoperative injuries occurred, nine of them were lumbar radiculopathies. Our new criteria, a decrease MEP area of 70%, yielded a sensitivity and specificity of 1, since it detected all the radicular injuries, with no false positive cases. Using a 70% amplitude decrease criteria, we obtained a sensitivity of 0,89 and a specificity of 0,99. A lower threshold (65% amplitude reduction) yielded a higher number of false positives, whereas a higher threshold (75 and 80%) gave rise to a higher number of false negatives. CONCLUSIONS: The measurement of the MEP area gave evidence to be more reliable and accurate than the measurement of the amplitude reduction in order to assess and detect intraoperative radicular injuries. SIGNIFICANCE: The criterion of decrease of the MEP area has a higher reliability and accuracy in the detection of intraoperative radicular lesions than the amplitude reduction.

Indicator condition based HIV testing: Missed opportunities for earlier diagnosis in men who have sex with men. / La prueba del VIH orientada por condiciones indicadoras: oportunidades perdidas para adelantar el diagnóstico de la infección en hombres que tienen sexo con hombres.

INTRODUCTION: Contact with the healthcare system by a sample of seropositive men who have sex with men (MSM) prior to their HIV diagnosis are analysed, and missed opportunities (MO) for an earlier HIV diagnosis are identified. METHODOLOGY: Between 2012-2013, an online survey was conducted among HIV-positive MSM, mainly recruited from gay websites. Those who were diagnosed with HIV between 2010-2013 were analysed. MO were defined as episodes prior to the HIV diagnosis in which the healthcare system was contacted due to an indicator condition of HIV infection and the test was not suggested. The proportion of missed opportunities were compared according to the type of indicator condition, the department consulted and the healthcare professional's knowledge that the patient was MSM. RESULTS: Overall, 639 participants (66% of 966) reported 1,145 episodes with some indicator condition, the majority of these being identified in primary care (n=527; 46%). The highest percentage of MOs is also observed in primary care (63%). Although the indicator condition with the highest number of MOs was STIs (n=124), the highest percentage of MOs was observed in consultations due to diarrhoea with no known cause (69.8%). The percentage of MOs when the doctor knew that the patient was MSM was 40 vs. 70% when the doctor did not know. CONCLUSION: The majority of HIV-positive MSM analysed in this study went to healthcare services for HIV-infection indicator conditions prior to their HIV diagnosis. Primary care was the most-frequently-visited department and is also where the most opportunities were missed to perform an HIV test, even when it was known that the patient was a MSM.

Neurophysiological mechanism of possibly confounding peripheral activation of the facial nerve during corticobulbar tract monitoring.

OBJECTIVE: To improve the recognition and possibly prevent confounding peripheral activation of the facial nerve caused by leaking transcranial electrical stimulation (TES) current during corticobulbar tract monitoring. METHODS: We applied a single stimulus and a short train of electrical stimuli directly to the extracranial portion of the facial nerve. We compared the peripherally elicited compound muscle action potential (CMAP) of the facial nerve with the responses elicited by TES during intraoperative monitoring of the corticobulbar tract. RESULTS: A single stimulus applied directly to the facial nerve at subthreshold intensities did not evoke a CMAP, whereas short trains of subthreshold stimuli repeatedly evoked CMAPs. This is due to the phenomenon of sub- or near-threshold super excitability of the cranial nerve. Therefore, the facial responses evoked by short trains TES, when the leaked current reaches the facial nerve at sub- or near-threshold intensity, could lead to false interpretation. CONCLUSIONS: Our results revealed a potential pitfall in the current methodology for facial corticobulbar tract monitoring that is due to the activation of the facial nerve by subthreshold trains of stimuli. This study proposes a new criterion to exclude peripheral activation during corticobulbar tract monitoring. SIGNIFICANCE: The failure to recognize and avoid facial nerve activation due to leaking current in the peripheral portion of the facial nerve during TES decreases the reliability of corticobulbar tract monitoring by increasing the possibility of false interpretation.

New methodology for facial nerve monitoring in extracranial surgeries of vascular malformations.

OBJECTIVE: To develop a more reliable methodology for monitoring the facial nerve in surgeries of vascular malformations where the extracranial segment of the nerve is at risk. METHODS: Our methodology comprises: (1) preoperative mapping to identify the anatomical location of the nerve branches, (2) continuous intraoperative monitoring of the compound muscle action potential (CMAP) by stimulating the facial nerve extracranially, in close proximity to where the trunk of the facial nerve exits the skull at the stylomastoid foramen, (3) intraoperative mapping to identify the nerve branches during surgical dissection and quantify the innervating contribution of each branch to the target muscle. RESULTS: Only three out of 201 surgeries (1.5%) had complete facial nerve trunk injury as a consequence of facial vascular malformation surgery. CONCLUSIONS: We developed a new method to continuously stimulate the facial nerve extracranially eliciting an objective parameter--the CMAP amplitude--to constantly measure changes in the muscle responses throughout surgery, alerting the surgeon before the facial nerve is severely injured. Our methodology notably reduces the complete facial nerve injury during extracranial surgery of facial vascular malformations. SIGNIFICANCE: This comprehensive methodology may also be a valuable tool to prevent facial nerve injury during other types of extracranial surgeries where radical excisions are required.

Sonographic measurement of cross-sectional area of the median nerve in the diagnosis of carpal tunnel syndrome: correlation with nerve conduction studies.

PURPOSE: To assess the usefulness of sonographic measurement of the median nerve cross-sectional area (CSA) in the diagnosis of carpal tunnel syndrome (CTS) and grading of its severity using nerve conduction (NC) studies as the standard. METHOD: The CSA of the median nerve was measured at the tunnel inlet and outlet using the ellipse formula and automatic tracing in 72 hands with suspicion of CTS. RESULT: The lack of inter-reader reliability led to excluding CSA measurements obtained at the tunnel outlet. Based on the receiver operating characteristic curves, the following cut-off points for the CSA of the median nerve at the tunnel inlet was selected: 9.8 mm and 12.3 mm(2) for the ellipse formula and 11 and 13 mm(2) for automatic tracing. For the ellipse formula, a CSA less than or equal to 9.8 mm(2) excluded CTS whereas a CSA greater than or equal to 12.3 mm(2) was diagnostic of CTS with measurements between 9.8 and 12.3 mm(2) being indeterminate and requiring NC studies. For automatic tracing, the cutoff value of 11 mm(2) was excluded because of the high percentage of false negatives, whereas CSAs greater than or equal to 13 mm(2) were diagnostic of CTS. There were no statistically significant differences in CSA measurements between the various degrees of CTS severity determined by NC studies. CONCLUSION: Sonographic measurement of median nerve CSA at the tunnel inlet is a good alternative to NC studies as the initial diagnostic test for CTS, but it cannot grade the severity of CTS as well as NC studies.