Human Papillomavirus (HPV) Education and Knowledge Among Medical and Dental Trainees.

Persistent human papillomavirus (HPV) infection is responsible for the majority of oropharyngeal and cervical cancers in the USA. Currently, HPV curricula within medical and dental schools are not standardized. As such, we implemented a brief online educational intervention to increase medical and dental trainees' knowledge of the HPV vaccine and the association between HPV and cancer. The objectives of this study were to (1) assess medical and dental trainees' baseline knowledge regarding HPV and HPV vaccine, (2) determine the willingness to recommend the HPV vaccine to patients, and (3) evaluate the impact of an online intervention on HPV-related knowledge. Medical and dental trainees from two large academic centers in the USA were asked to fill out an online pre-intervention questionnaire, followed by a 10-min HPV educational intervention based on the Center of Disease Control and Prevention (CDC) resources, and then a post-intervention questionnaire. There were 75 participants (67.4% females; median age 18-30 years). When asked about HPV-related cancer types, the correct response increased from 28.4% (pre-intervention) to 51.9% (post-intervention; p < 0.01). When asked about the prevalence of HPV infections, the correct response improved from 36 to 72% (p < 0.01). There was also a 25.2% improvement in identifying the correct HPV vaccination dosing schedule (p < 0.01). Eighty-seven percent of the participants mentioned that the online education improved their HPV knowledge, and 68.5% reported that they were more likely to recommend HPV vaccine after the online intervention. The proposed online educational intervention was effective at improving HPV-related cancer and HPV vaccine knowledge as well as attitudes towards vaccine recommendation among dental and medical trainees and could be implemented in medical and dental school curricula in the future.

Outcomes by Race Among Women Referred to an Academic Colposcopy Clinic with a Patient Navigation Program.

Background: Although minority women are at higher risk of cervical cancer in the United States, little is known about differences in rates of colposcopy and loop electrosurgical excision procedure (LEEP) by race once patients present for care. Materials and Methods: A prospective registry of patients presenting to an academic colposcopy clinic was queried from 2008 to 2018. Women with missing race or cytology results, prior hysterectomy, or prior history of cervical, vulvar, or vaginal cancer were excluded. Poisson and logistic regression models were performed to evaluate the associations between race and colposcopy, LEEP, and cancer rates, adjusting for referral Papanicolaou (Pap), human papillomavirus (HPV) result, year of visit, age, insurance, pregnancy, number of sexual partners, and smoking status. Results: A total of 4506 women were included (56.1% white and 43.9% non-white). Referral for high-grade cytology was more likely among white compared to non-white women (22.5% vs. 17.5%, p < 0.001), as well as positive HPV testing (white 7.8% vs. non-white 6.0%, p < 0.001). The colposcopy rate was slightly higher among black (incidence rate ratio [IRR]adjusted 1.11, 95% confidence interval [CI] 1.03-1.19, p = 0.006) and Hispanic women (IRRadjusted 1.13, 95% CI 1.06-1.21, p = 0.0003) compared to white women. Hispanic women were significantly more likely to undergo LEEP (odds ratioadjusted 1.26, 95% CI 1.01-1.58, p = 0.04). However, no significant difference in cancer, adenocarcinoma in situ, or high-grade histology was noted by race. Conclusions: Black and Hispanic women referred for abnormal Pap or HPV results underwent a greater number of colposcopies compared to white women, and Hispanic women underwent a greater number of LEEPs. Although cancer is rare in our cohort, there was no statistical difference in rate of cancer by race.

Tablet-Based Patient Education Regarding Human Papillomavirus Vaccination in Colposcopy Clinic.

OBJECTIVE: The aim of this study was to use an electronic tablet-based education module to increase patient knowledge about human papillomavirus (HPV). METHODS: Patients presenting to an academic colposcopy clinic were first queried as to whether they had been infected with HPV. A quality improvement project was then conducted using a 4-question pretest assessing baseline knowledge about HPV and cancer, followed by a tablet-based education module and a 5-question posttest. RESULTS: Between June 2017 and January 2018, 119 patients participated in the tablet education. At their initial visit, only 50 (42.0%) of patients were aware that they had an HPV infection; however, medical records revealed that 74 women (62.2%) were presenting with a documented HPV infection. After the tablet education, 95% of women identified cervical cancer as a problem that can be caused by HPV, as compared with 88.2% in the pretest (p = .046). Knowledge of head and neck cancer as a disease that can be caused by HPV increased from 10.9% to 80.7% (p < .001). More patients answered that they "definitely" or "probably" would consider the vaccine for a child in their family: 108 (95.6%) pretest vs. 112 (99.1%) posttest (p = .046). The activities were ranked as "extremely" or "very" helpful by 93.3% of patients. CONCLUSIONS: Patients presenting to colposcopy clinic are not well educated regarding the connection between an abnormal Pap test, HPV infection, and certain cancers. Tablet-based education improves patient knowledge of HPV-associated cancers in an outpatient clinic setting.

Modeling ecotoxicity impacts in vineyard production: Addressing spatial differentiation for copper fungicides.

Application of plant protection products (PPP) is a fundamental practice for viticulture. Life Cycle Assessment (LCA) has proved to be a useful tool to assess the environmental performance of agricultural production, where including toxicity-related impacts for PPP use is still associated with methodological limitations, especially for inorganic (i.e. metal-based) pesticides. Downy mildew is one of the most severe diseases for vineyard production. For disease control, copper-based fungicides are the most effective and used PPP in both conventional and organic viticulture. This study aims to improve the toxicity-related characterization of copper-based fungicides (Cu) for LCA studies. Potential freshwater ecotoxicity impacts of 12 active ingredients used to control downy mildew in European vineyards were quantified and compared. Soil ecotoxicity impacts were calculated for specific soil chemistries and textures. To introduce spatial differentiation for Cu in freshwater and soil ecotoxicity characterization, we used 7 European water archetypes and a set of 15,034 non-calcareous vineyard soils for 4 agricultural scenarios. Cu ranked as the most impacting substance for potential freshwater ecotoxicity among the 12 studied active ingredients. With the inclusion of spatial differentiation, Cu toxicity potentials vary 3 orders of magnitude, making variation according to water archetypes potentially relevant. In the case of non-calcareous soils ecotoxicity characterization, the variability of Cu impacts in different receiving environments is about 2 orders of magnitude. Our results show that Cu potential toxicity depends mainly on its capacity to interact with the emission site, and the dynamics of this interaction (speciation). These results represent a better approximation to understand Cu potential toxicity impact profiles, assisting decision makers to better understand copper behavior concerning the receiving environment and therefore how restrictions on the use of copper-based fungicides should be considered in relation to the emission site.

Effect of patient navigator program on no-show rates at an academic referral colposcopy clinic.

BACKGROUND: Patient navigators have been used successfully to guide vulnerable patients through barriers to cancer care and reduce disparities in cancer outcomes. This study evaluated the effect of a patient navigator program on no-show rates at a tertiary care referral colposcopy center and explored factors associated with missed appointments. METHODS: No-show rates prior and subsequent to implementation of the intervention were compared by chi-square test. We compared patient demographic, lifestyle, and diagnostic characteristics between patients who had ever and never missed appointments. We described patient-reported barriers to care. RESULTS: Of 4,199 women evaluated in our clinic from January 2006 to December 2013, 2,441 (58%) had at least one missed appointment. African American, Hispanic, and publicly insured women tended to miss appointments more frequently than did white and privately insured women (p<0.0001). Patients who missed appointments tended to have more abnormal cytology (p<0.0001), cervical pathology (p=0.007), and vulvar pathology (p=0.001). No-show rates declined from 49.7% to 29.5% after implementation of the patient navigator program (p<0.0001). We found that 45% of patient no-shows were anticipated or a result of patient misunderstanding and could be mediated with targeted education by the patient navigator. CONCLUSIONS: Patient navigator programs at referral centers reduce no-show rates, thus improving patient follow-up, which may reduce disparities in cervical cancer screening and treatment.

Whiplash syndrome and forensic approach. A case report / Síndrome de latigazo cervical y abordaje forense: reportaje de un caso

The same day as being involved in a traffic incident as a pedestrian hit by a car, a middle-aged woman accessed emergency medical care and was later discharged. After two days the patient returned to emergency with complaints of neck pain. X-rays were conducted was immobilized with a cervical collar. Since the pain persisted, she was examined a few days later by physiatry, where a limitation in the arc of motion of the neck was found and whiplash was considered a possibility. This type of cases related to chronic posttraumatic pain are relatively common in clinical consultation and represent a great challenge for physicians, mainly in the forensic field, since there are often many symptoms and very few signs to identify the damage. Therefore, a forensic doctor must recur to the clinical history and carefully examine the mechanism of injury and the evolution of the clinical presentation, in addition to calling on other disciplines such as orthopedics, physiatry, psychiatry and pain medicine to issue a definitive concept.

Una mujer de edad mediana sufrió un accidente de tránsito como peatón al ser arrollada por un automóvil, este mismo día recibió atención mediante el servicio médico de urgencias dándosele de alta posteriormente. A los dos días la mujer consultó nuevamente el servicio de urgencias por dolor cervical, le realizaron radiografías y le inmovilizaron con cuello ortopédico. Dada la persistencia de dolor cervical, días después fue valorada por fisiatría, donde encontraron limitación para arcos de movimiento del cuello y se consideró posible síndrome de latigazo cervical. Este tipo de casos relacionados con dolor crónico postraumático es relativamente frecuente en la consulta clínica y reviste un gran reto para los médicos, principalmente en el campo forense, ya que con frecuencia hay muchos síntomas y muy pocos signos que logren objetivar el daño. De esta manera, el médico forense debe recurrir a la historia clínica y escudriñar detalladamente el mecanismo de lesión y la evolución del cuadro clínico, además de pedir el concepto de varias disciplinas como ortopedia, fisiatría, psiquiatría y medicina del dolor, para emitir su concepto definitivo.

Impact of telemedicine assessment on glycemic variability in children with type 1 diabetes mellitus.

BACKGROUND: Experimental and in vitro studies have related glycemic variability (GV) with activation of oxidative stress, which could be involved in the micro- and macrovascular damage found in diabetes mellitus and in acute complications such as hypoglycemia. Some GV indexes are currently integrated in specialized Web sites for the analysis and assessment of diabetes patients through telemedicine. We aimed to identify the impact of telemedicine on metabolic control and GV in prepubescent patients with type 1 diabetes mellitus (T1DM). SUBJECTS AND METHODS: Eighty patients between 6 and 10 years old were eligible for enrollment. Participation was accepted by the parents of only 15 (18%) patients, of whom 13 (86%) completed the study. These 13 patients were assessed fortnightly for 3 months through Accu-Chek (Roche, Mannheim, Germany) Smart Pix software; this period was compared with a subsequent 4-month period without telemedical support. The variables analyzed were mean glycated hemoglobin (HbA1c), mean blood glucose (MBG), and indexes of GV (SD, low blood glucose index [LBGI], high blood glucose index [HBGI], and the average daily risk range [ADRR]). In both periods, the patients attended their regular appointments. The statistical analysis was carried out with nonparametric tests (the Wilcoxon and Friedman tests, P<0.017). RESULTS: At the end of the assessment phase, mean HbA1c levels were significantly reduced (P=0.012) with no significant reductions in the LBGI (P=0.115), ADRR (P=0.552), or SD (P=0.700). No significant increases were observed in MBG (P=0.861) or the HBGI (P=0.807). HbA1c and the LBGI, ADRR, and SD indexes increased when telemedical assistance was suspended, whereas MBG and the HBGI showed a nonsignificant reduction. CONCLUSIONS: Telemedical assessment for 3 months in children improved metabolic control, by reducing HbAlc values and, to a lesser extent, by decreasing GV, without increasing acute complications. Metabolic control was reduced when the advice was suspended.

Triple A syndrome in a patient with genetic growth hormone insensitivity: phenotypic effects of two genetic disorders.

BACKGROUND: Primary growth hormone insensitivity (GHI) and triple A syndrome are rare autosomal recessive disorders. CASE REPORT: The patient, a 12-year-old boy from consanguineous parents, was referred for short stature at the age of 7 years (height: -5.4 SD score). He had low serum insulin-like growth factor I (IGF-I) and IGF binding protein 3 and a blunted IGF-I response to recombinant human GH; molecular analysis of the GH receptor disclosed a homozygous A(-1)→G(-1) at the 5' pseudoexon 6Ψ splice site. Recombinant IGF-I therapy (mecasermin, Increlex®, twice daily) initiated at the age of 9 years resulted in an increase of height velocity (HV) from 4.0 to 9.5 cm/year. At the age of 10.5 years, he presented with asthenia, anorexia, weight loss, a decrease in HV and very low cortisol levels; adrenal insufficiency was confirmed and glucocorticoid therapy was initiated. Subsequent peripheral motor neuropathy, achalasia and alacrima raised the suspicion of triple A syndrome, which was confirmed by the presence of a homozygous R194X mutation in the AAAS gene. CONCLUSION: This unusual combination of diseases, to our knowledge, has not been reported to date. Although the patient responded to recombinant IGF-I therapy for GHI, we hypothesize that the treatment could have had an inhibitory effect on 11ß-hydroxysteroid dehydrogenase type 1 activity, thereby reducing the availability of cortisol and precipitating adrenal insufficiency.

Guía jurídica sobre violencia intrafamiliar / Legal guide about violence in the family

La elaboración de la guía jurídica sobre violencia intrafamiliar, instrumento destinado a profesionales y técnicos de las diferentes instituciones que abordan la temática, asimismo encontrarán información básica necesaria e instancias facultadas por ley, para atender y prevenir este mal social inevitable

Factores de riesgo del cancer cervico-uterino / Factors of risk of the cervico-uterine cancer

Contiene: Planteamiento del problema,proposito,objetivo,poblacion estudiada y muestras,metodologia seleccion de variedades,recoleccion de datos