An Analysis of Chaplains' Narrative Chart Notes Describing Spiritual Care Visits with Gender Affirmation Surgical Patients.

Purpose: The benefit of spiritual care for patients is well described, but little is known about the role of spiritual care in transgender and nonbinary patients recovering from gender affirming surgeries (GASs). Methods: A single-center retrospective chart review was performed on patients who underwent GAS in 2017. Demographic information, surgery type, and chaplains' narrative notes were examined. Results: A total of 145 chaplain visits were identified in 103 inpatient stays among 98 patients at the Mount Sinai Center for Transgender Medicine and Surgery in New York. Analysis was performed on narrative notes authored by a single chaplain, which included 132 visits among 78 transfeminine and 11 transmasculine patients. Fifty-four patients (61%) expressed gratitude for the chaplain visit and/or hospital experience overall. Seven patients (8%) described movement between religious denominations over the course of their lives, and 7 (8%) described supportive belief systems. Fifty-seven patients (64%) had a family member or friend present during the perioperative process, 13 (15%) described support systems, and 9 (10%) described supportive practices, activities, and/or coping methods. Twenty-one patients (24%) expressed concerns about current symptoms or the recovery process, and 32 (36%) received a prayer or blessing from the chaplain. Fifty-two patients (58%) consented to a follow-up call. Conclusion: Almost 50% of patients expressed gratitude for the chaplain's visit and more than half consented to a follow-up call from the chaplain, suggesting a chaplain can provide a welcome layer of support to postoperative GAS patients. The authors recommend integrating spiritual care into perioperative care.

Common Mental Disorders at the Time of Deportation: A Survey at the Mexico-United States Border.

Deportations from the Unites States (US) to Mexico increased substantially during the last decade. Considering deportation as a stressful event with potential consequences on mental health, we aimed to (1) estimate the prevalence of common mental disorders (CMD) among deported migrants; and (2) explore the association between migratory experience, social support and psychological variables, and CMD in this group. In repatriation points along the border, a probability sample of deportees responded to the Self Reporting Questionnaire (SRQ). The prevalence of CMD was 16.0% (95% CI 12.3, 20.6). There was a U-shaped association between time in the US and SRQ score. Times returned to Mexico, having a spouse in the US, number of persons in household, less social support, anxiety as a personality trait, and avoidant coping style were directly associated with SRQ score. Public health policies should address the need for mental health care among deported migrants.

Actinomycetoma by Nocardia brasiliensis in a girl with Down syndrome.

We describe the case of a 14-year-old girl with Down syndrome and a large cutaneous plaque localized to the right neck and shoulder that had enlarged over five years after a minor traumatic injury. The plaque was characterized by numerous inflammatory nodules and fistulae that secreted purulent discharge. Nocardia grains were identified and Nocardia brasiliensis was identified by culture. Histopathology examination showed a chronic inflammatory infiltrate with granuloma development. The treatment scheme was with Diaminodiphenylsulfone 50/mg/d and Trimethoprim-Sulfamethoxazole 800/160 mg BID. Therapy was continued over 1(1/2) years, with a tapering dose. After 2(1/2) years of continuous treatment, clinical and microbiological healing was achieved.

Comparative analysis of cognitive impairment among Mexicans and Spanish-speaking immigrant's elders.

OBJECTIVE: This study aims to compare the prevalence of cognitive impairment among older Mexicans and Spanish-speaking U.S. immigrants. METHODS: The relationship of cognitive impairment with social and demographic variables was explored using data from five different population based survey studies. RESULTS: Prevalence rates increased with age, with low educational level, didn't show a clear association with gender and decreased in married subjects. Estimates of cognitive and functional impairment combined are greater in the immigrant samples than those for Mexican residents. Primary memory measures are the least discriminative for cognitive impairment, whereas orientation, attention, and secondary verbal memory measures discriminate better. DISCUSSION: Mexicans and Spanish-speaking USA immigrants have similar prevalence estimates of cognitive impairment. However, prevalence of functional impairment differs between Mexicans and immigrants because of measurement issues and cultural factors.

Treatment of nail bed defects with hard palate mucosal grafts.

BACKGROUND: Nail bed defects produce a nail plate dystrophy that is permanent and presents important cosmetic problems. To correct the defect, we used a hard palate mucosal graft. This is a procedure with encouraging outcomes for nail bed scars. OBJECTIVE: To show our initial experience with the hard palate mucosal graft technique for correcting nail dystrophy or permanent onycholysis secondary to a nail bed scar. METHODS: This was a prospective, longitudinal, descriptive, observational study. We included five patients with a traumatic nail bed scar and one patient with congenital dystrophy. Seven nails were treated using a hard palate mucosal graft. RESULTS: All repaired nails had a good outcome, with excellent growth and improvement in nail dystrophy. The patients had surgical recovery in 2 weeks and tolerable pain. CONCLUSIONS: This is a relatively easy procedure for experienced surgeons to correct nail dystrophy secondary to a nail bed scar, with good to excellent results.

Cognition, functional status, education, and the diagnosis of dementia and mild cognitive impairment in Spanish-speaking elderly.

A group of 314 Spanish-speaking elders were classified in 55 participants with mild to moderate dementia, 74 participants with mild cognitive impairment (MCI), and 185 control participants, according to clinical evaluation derived. Sensitivity, specificity, and detection characteristics of frequently cognitive and functional tests were calculated in comparison with the clinical evaluation: Minimental State Examination, Brief Neuropsychological Test Battery, Short Blessed test, Pfeffer Functional Activities Questionnaire, and Blessed Dementia Scale. Influence of education on sensitivity and specificity values varied along the tests. For all the cognitive and functional measures, a great number of MCI participants who fulfilled Mayo's (Mayo's Clinical School) clinical criteria (Petersen et al., 1999) were misclassified as controls and a few were misclassified as demented. Level of education plays a very important role in both cognitive and functional assessment. The cognitive tests that are commonly used to screen demented patients may fail to detect MCI particularly in high-functioning individuals as well as those who are well educated.

Nongenetic factors as modifiers of the age of onset of familial Alzheimer's disease.

OBJECTIVE: The purpose of this research was to identify environmental and personal factors that could be related to the variability in the age of onset of familial Alzheimer's disease (FAD) (36-62 years). METHODS: A sample was taken of 49 subjects with FAD and with the mutation E280A in the presenilin-1 gene on chromosome 14; the sample was divided into two subgroups: 27 individuals with age of onset of the disease between 36 and 46 years (early onset) and 22 individuals whose disease began between 47 and 62 years (late onset). Information on environmental and personal factors was collected by means of a questionnaire answered by the patients if their clinical condition allowed it, or by their relatives; such information was organized in a categorical way. Comparisons between the two groups for each categorical variable were done by means of the chi-square test. Noncollinear variables that showed statistical significance were included as independent variables in a logistic regression analysis to predict their association with early onset of the disease. RESULTS: Only 5 of the 140 studied variables were different between the two groups in univariate analysis: education, surgical history, type of stressful event, depression, and affective losses. The logistic regression model was constituted by education, depression, and affective losses. High-level education had approximately 15 times more probability of association with an early onset of the disease; both the history of affective losses and depressive symptoms had 4 times more probability of a similar association. CONCLUSIONS: The association of high-level education and early onset of the disease could be related to an earlier detection of symptoms, in turn determined by greater intellectual and environmental demands. The occurrence of depression and affective losses has been considered a prodromic manifestation of the disease. Our findings are evidence of high clinical heterogeneity even in a genetically homogeneous group.

Heterogeneidad en la prueba de Boston para las afasias (BDAE) determinada por las variables demográficas en un grupo de personas laboralmente activas / Cultural and demographic variables effect on the norming data of the Boston Diagnostic Aphasia Examination (BDAE) in normal and occupational active subjects

El objetivo de la investigación fue analizar la influencia de algunas variables culturales y demográficas que afectan los datos estandarizados de la prueba de Boston para el diagnóstico de las afasias. Un análisis múltiple de varianza (Manova) demostró que el sexo determinó diferencias estadísticamente significativas (p<0,05) sólo en variables de lectura y escritura. El grupo de nivel socioeconómico bajo, obtuvo puntajes significativamente más bajos en identificación y denominación de las partes del cuerpo. La mayoría de las diferencias estadísticamente significativas estuvieron determinadas por las diferencias de escolaridad. La edad determinó diferencias significativas en denominación por confrontación visual y en el item de lectura en voz alta entre los grupos jóvenes y de adultos de edad media. La escritura seriada y al dictado fueron significamente diferentes entre los grupos de jóvenes y adultos mayores. La ocupación sólo determinó diferencias en el deletreo oral, con puntajes significativamente más bajos en los trabajadores manuales. La escolaridad es una variable demográfica y cultural que determina diferencias significativas en la mayoría de los item del BDAE que deben ser analizadas cuidadosamente por el clínico al hacer los perfiles diagnósticos de los pacientes afásicos