"We do it ourselves": strengths and opportunities for improving the practice of harm reduction.

BACKGROUND: Unprecedented increases in substance-related overdose fatalities have been observed in Texas and the U.S. since the onset of the COVID-19 pandemic and have made clear there is considerable need to reduce harms associated with drug use. At the federal level, initiatives have called for widespread dissemination and implementation of evidence-based harm reduction practices to reduce overdose deaths. Implementation of harm reduction strategies is challenging in Texas. There is a paucity of literature on understanding current harm reduction practices in Texas. As such, this qualitative study aims to understand harm reduction practices among people who use drugs (PWUD), harm reductionists, and emergency responders across four counties in Texas. This work would inform future efforts to scale and spread harm reduction in Texas. METHODS: Semi-structured qualitative interviews were conducted with N = 69 key stakeholders (25 harm reductionists; 24 PWUD; 20 emergency responders). Interviews were transcribed verbatim, coded for emergent themes, and analyzed using Applied Thematic Analysis with Nvivo 12. A community advisory board defined the research questions, reviewed the emergent themes, and assisted with interpretation of the data. RESULTS: Emergent themes highlighted barriers to harm reduction at micro and macro levels, from the individual experience of PWUD and harm reductionists to systemic issues in healthcare and the emergency medical response system. Specifically, (1) Texas has existing strengths in overdose prevention and response efforts on which to build, (2) PWUD are fearful of interacting with healthcare and 911 systems, (3) harm reductionists are in increasing need of support for reaching all PWUD communities, and (4) state-level policies may hinder widespread implementation and adoption of evidence-based harm reduction practices. CONCLUSIONS: Perspectives from harm reduction stakeholders highlighted existing strengths, avenues for improvement, and specific barriers that currently exist to harm reduction practices in Texas.

Fragilidad y depresión en el adulto mayor hospitalizado / Frailty and Depression in hospitalized older adults

Introducción: el síndrome de fragilidad se caracteriza por la disminución de la reserva fisiológica y una menor resistencia a los factores estresantes, como resultado del deterioro progresivo en los sistemas fisiológicos. Objetivo: determinar la relación de fragilidad y depresión en el adulto mayor hospitalizado. Metodología: estudio descriptivo, transversal y correlacional. Se incluyeron adultos mayores hospitalizados en una unidad médica de tercer nivel con edad mínima de 70 años. Se utilizó la escala FRAIL versión mexicana para la fragilidad y la escala de depresión geriátrica de Yesavage. Para la prueba de normalidad de las escalas se utilizó la prueba de Shapiro-Wilk, y para obtener la correspondencia de las variables el coeficiente de correlación de Pearson. Resultados: se incluyeron 31 adultos mayores con edad promedio de 75 años (± 3.4), 14 (45.2%) mujeres y 17 (54.8%) hombres. Para la escala de fragilidad y depresión se encontró: w = 0.053 y w = 0.059, respectivamente. Se obtuvo un coeficiente de correlación de Pearson de 0.709. Conclusión: se determinó que existe correlación entre la fragilidad y la depresión en el adulto mayor hospitalizado.

Introduction: The frailty syndrome is characterized by decreased physiological reserve and decreased resistance to stressors, as a result of progressive deterioration in physiological systems. Objective: To determine the relationship between frailty and depression in hospitalized older adults. Methods: Descriptive, cross-sectional, and correlational study. Were included older adults hospitalized in a third level care unit with a minimum age of 70 years. The FRAIL Mexican version Scale for frailty and the Yesavage Geriatric Depression Scale were used. For the normality test of the scales, the Shapiro-Wilk test was used, and the Pearson correlation coefficient was used to obtain the correspondence of the variables. Results: Thirty-one older adults with a mean age of 75 years (± 3.4) were included, 14 (45.2%) women and 17 (54.8%) men. For the Fraility and Depression scale were found a w = 0.053 and w = 0.059, respectively. A Pearson correlation coefficient of 0.709 was obtained. Conclusion: There is a correlation between frailty and depression in hospitalized older adults.

Efectividad del Programa Educativo "Exprésate" en el nivel de conocimientos y actitudes hacia la prevención del embarazo en adolescente en la Institución Educativa Peruano Suizo - Comas 2011 / Effectiveness of the Educational Program Express Yourself in the level of knowledge and attitudes toward adolescent pregnancy prevention in the Educational lnstitution Peruano Suizo - Comas 2011

El embarazo en la adolescencia es una condición que se sobreimpone a la etapa adolescente, presentando consecuencias múltiples y devastadoras, afectando de manera determinante el futuro y el proyecto de vida de los y las adolescentes; no obstante, esta problemática puede ser prevenida por el personal sanitario, por lo cual se realiza el presente estudio de investigación titulado: Efectividad del Programa Educativo "Exprésate" en el Nivel de Conocimientos y Actitudes hacia la Prevención del Embarazo Adolescente en la Institución Educativa "Peruano Suizo" - Comas 2011. Este estudio es de tipo analítico, de enfoque cuantitativo, de nivel aplicativo, con un diseño cuasiexperimental de grupo único con pre - test y post - test. La población está conformada por 337 estudiantes del tercero y cuarto año de educación secundaria distribuidos en 10 secciones en los turnos mañana y tarde; de los cuáles se realizó un muestreo probabilístico aleatorio simple sin reemplazo para proporciones y se seleccionó una muestra representativa de 168 estudiantes distribuidos en 5 secciones consideradas de mayor riesgo a presentar embarazos adolescentes. El objetivo general del estudio es determinar la efectividad del Programa Educativo "Exprésate" en el Nivel de Conocimientos y Actitudes hacia la Prevención del Embarazo Adolescente; utilizando como instrumentos de recolección de datos a un cuestionario de alternativas múltiples y una escala tipo Likert, cuya aplicación se dio antes y después de la intervención con programa educativo diseñado. La validez de los instrumentos estuvo dada por la prueba binomial aplicada por los jueces expertos, y la confiabilidad se realizó mediante las pruebas estadísticas de Kuder Richardson (KR20) para el cuestionario de conocimientos y alta de Cronbach para la escala de actitudes, obteniéndose un α>0.72 y α>0.79 respectivamente. La contrastación de hipótesis fue dada por la prueba de rangos de Wilcoxon para muestras relacionadas obteniéndose un p-valor<0.05 siendo "Significativo" y un Zc=-10.804 probándose la efectividad del programa educativo. La conclusión principal del estudio es que el Programa Educativo "Exprésate" es efectivo, evidenciándose un incremento del nivel de conocimientos de Bajo (12.18 por ciento) y Medio (87.82 por ciento) a nivel Alto (100 por ciento) y produciéndose modificación de actitudes desfavorables a favorables (100 por ciento) de la muestra participante

Adolescent pregnancy is a condition that ís superimposed on the adolescent stage, presenting multiple and devastating consequences, affecting the future and the life project of adolescents decisively, however, this problem can be prevented by health professional, deciding investigated about: Effectiveness of the Educational Program "Express Yourself” in the Level of Knowledge and Attitudes toward Adolescent Pregnancy Prevention in the Educational lnstitution "Peruano Suizo" - Comas 2011. This research study is analytic, quantitative approach, application level, with a unique group quasi-experimental design with pre - test and post - test. The population consists of 337 students of the third and fourth year of secondary education divided into 10 sections in morning and afternoon shifts in Educational Institution "Peruano Suizo" in Comas, producing a probabilistic, simple random sampling without replacement for proportions and selected a representative sample of 168 students divided into 5 sections considered to present increased risk of adolescent pregnancy. The overall objective of the study is to determine the Effectiveness of the Educational Program "Express Yourself” in the Level of Knowledge and Attitudes to Prevent Adolescent Pregnancy, using as data collection instrumenls to a multiple choice questionnaire and a Likert scale before and after educational intervention designed. The validity of the instruments was given by the binomial test applied by the expert judges, and reliability was performed using statistical tests, Kuder Richardson (KR20) for the knowledge questionnaire and Cronbach's alpha for the attitude scale, generating α>0.72 y α>0.79 respectively. The hypothesis testing was given by the Wilcoxon rank test for related samples generating the p-value<0.05 "Significant" and Zc=-10,804 proving the effectiveness of the educational program. The main conclusion of the study is that the Educational Program "Express Yourself” is effective demonstrating an increased level of knowledge of Lower (12.18 per cent) and Middle (87.82 per cent) at high (100 per cent) and producing changes unfavorable to favorable attitudes (100 per cent) of the sample participant

Performance of an algorithm for assessing smallpox risk among patients with rashes that may be confused with smallpox.

After the 2001 anthrax bioterror attacks, the Centers for Disease Control and Prevention developed an algorithm to evaluate patients rapidly for suspected smallpox. A prospective, multicenter study examined the performance of this algorithm in assessing patients with an acute, generalized vesicular or pustular rash (AGVPR) admitted to emergency departments and inpatient units of 12 acute-care hospitals in 6 states. Of 26,747 patients (3.5% of all admissions) with rashlike conditions screened, 89 (1.2 patients per 10,000 admissions) had an AGVPR. Physicians or study staff classified none of 73 enrolled patients as being at high risk for having smallpox; 72 (99%) were classified as being at low risk, and 1 was classified as being at moderate risk. The discharge diagnosis for 55 (75%) of these 73 participants was varicella illness. Use of the algorithm did not result in misclassification of AGVPR as high risk for smallpox. The algorithm is a highly specific tool for clinical evaluation of suspected smallpox disease.

Consumo de Drogas en Costa Rica: resultados de la encuesta nacional 2006 / Drug Use in Costa Rica: Results of the 2006 National Survey

Esta investigación constituye el cuarto estudio de la serie que se iniciara en 1990. En aquella oportunidad se estableció que, en virtud de los recursos disponibles y por la evolución del fenómeno del consumo de sustancias, la periodicidad debería ser de cinco años, lapso que permitiría actualizar adecuadamente la información. Hoy día se hacen esfuerzos por acortarlo, no excesivamente, para obtener un panorama más preciso de un fenómeno cuyo desarrollo, en especial desde 1995, ha tenido algunos rasgos notables, como la evolución del consumo de "crack", marihuana y cocaína y, de mayor consideración, el alcohol y tabaco

Valoración global de la aptitud clínica de médicos familiares en el manejo de la diabetes mellitus con nefropatía inicial / Clinical aptitude of the family doctors front of sick patients with diabetes type two with initial nephropathy

The diabetic nephropathy in initial phase requires an opportune identification by family physicians. Indeed, they should be qualified to interpret the data that suggesting that a patient be going through that phase of the illness, in order to orientate the management and processing of the same one, from an integrative perspective. The purpose of this work was to measure the aptitude of the family doctors to interpret, to judge and to propose in front of sick patients with diabetes type two with initial nephropathy. We made this with a representative sample of family physicians in five Family Medicine Units of the Instituto Mexicano del Seguro Social in the city of Guadalajara, Jalisco, Mexico. The main variable of the study was the clinical aptitude of the doctors: interpretation, judgment and proposals carried out in the practice of their profession; and through an ordinal scale, levels of aptitude were defined, which related to the remainder of variables using the medium, Kruskal Wallis stadiometer and x2.

La nefropatía diabética en etapa inicial requiere de una oportuna identificación por parte de los médicos familiares. De hecho, ellos deberían estar capacitados para interpretar los datos que sugieren que el paciente está cursando esa etapa de la enfermedad, con el objetivo de orientar el manejo y tratamiento de la misma desde una perspectiva integradora. El propósito del presente trabajo fue medir la capacidad de aptitud clínica del médico, frente al caso clínico de un enfermo con diabetes tipo 2 con nefropatía inicial. Con este fin se utilizó un instrumento estructurado y validado, en una muestra representativa de 101 de 450 médicos familiares en cinco de veintitrés Unidades de Medicina Familiar del Instituto Mexicano del Seguro Social en la Ciudad de Guadalajara, Jalisco, elegidos por conglomerados en dos etapas. La principal variable de estudio fue la aptitud clínica de los médicos definida como la capacidad de interpretación, evaluación y propuestas que éstos realizan en la práctica de su profesión (indicadores de factores de riesgo, integración diagnóstica, uso de paraclínicos y recursos terapéuticos). Los niveles de aptitud se definieron a través de una escala ordinal y se relacionaron con el resto de variables utilizando la mediana, el estadígrafo de Kruskal Wallis, y la x2. La mediana de la aptitud clínica fue de 73 con rango de 18 a 113, al relacionar entre las unidades de atención médica. Con el resto de variables de estudio no se demostró diferencia estadísticamente significativa. Se concluye que 8% de los médicos familiares reúne la aptitud para el manejo de la nefropatía inicial del diabético 2.

[Clinical aptitude of family doctors in the management of patients with diabetes type two with initial nephropathy]. / Valoración global de la aptitud clínica de médicos familiares en el manejo de la diabetes mellitus con nefropatía inicial.

The diabetic nephropathy in initial phase requires an opportune identification by family physicians. Indeed, they should be qualified to interpret the data that suggesting that a patient be going through that phase of the illness, in order to orientate the management and processing of the same one, from an integrative perspective. The purpose of this work was to measure the aptitude of the family doctors to interpret, to judge and to propose in front of sick patients with diabetes type two with initial nephropathy. We made this with a representative sample of family physicians in five Family Medicine Units of the Instituto Mexicano del Seguro Social in the city of Guadalajara, Jalisco, Mexico. The main variable of the study was the clinical aptitude of the doctors: interpretation, judgment and proposals carried out in the practice of their profession; and through an ordinal scale, levels of aptitude' were defined, which related to the remainder of variables using the medium, Kruskal Wallis stadiometer and chi2.