Reopening schools safely and educating youth (ROSSEY) study: Protocol for a community-based, cluster randomized controlled trial.

INTRODUCTION: ROSSEY is a community-academic partnership aiming to develop and test a COVID-19 risk communication intervention for elementary school students and families in Yakima County, Washington. We describe the ROSSEY study protocol that will be implemented in the Yakima School District. METHODS: Aim 1 is to identify the community's social, ethical, and behavioral needs and resources for students to return to school and maintain onsite learning. We will conduct semi-structured interviews with students and school employees and focus groups with parents. Aim 2 is to evaluate the effectiveness of risk communication on students' school attendance. We will conduct a cluster randomized control trial. We will enroll 14 Yakima School District elementary schools with 900 student participants and randomize the schools into the COVID-19 risk communication intervention or control group. Aim 3 will assess implementation of the risk communication intervention and schools' COVID-19 mitigation strategies. We will use the RE-AIM framework to guide this work, which will entail conducting semi-structured interviews with students and school employees and focus groups with parents. DISCUSSION: Implementation of science-based risk communication can educate the community on the benefits and safety of COVID-19 testing and vaccination. Risk communication may also inform families about the role of COVID-19 testing and vaccines as part of mitigation strategies to allow for safe in-person learning. Schools have extraordinary influence to promote children's health through policy and practice change. Study findings will provide evidence to facilitate policy decisions and best practices at schools that facilitate adoption of COVID-19 risk communication. TRIAL REGISTRATION: ClinicalTrials.govNCT04859699. Registered on April 26, 2021.

Critical lessons from a pragmatic randomized trial of home-based COVID-19 testing in rural Native American and Latino communities.

PURPOSE: Native Americans and Latinos have higher COVID-19 infection and mortality rates and may have limited access to diagnostic testing. Home-based testing may improve access to care in rural and underserved populations. This study tests the effect of community health worker (CHW) support on accessibility, feasibility, and completion of COVID-19 home testing among Native American and Latino adults living on the Flathead Reservation in Montana and in Yakima Valley, Washington. METHODS: A two-arm, multisite, pragmatic randomized controlled trial was conducted using block randomization stratified by site and participant age. Active arm participants received CHW assistance with online COVID-19 test kit registration and virtual swabbing support. The passive arm participants received standard-of-care support from the kit vendor. Logistic regression modeled the association between study arm and test completion (primary outcome) and between study arm and test completion with return of valid test results (secondary outcome). Responses to posttest surveys and interviews were summarized using deductive thematic analysis. FINDINGS: Overall, 63% of participants (n = 268) completed COVID-19 tests, and 50% completed tests yielding a valid result. Active arm participants had higher odds of test completion (odds ratio: 1.66, 95% confidence interval [1.01, 2.75]). Differences were most pronounced among adults ≥60 years. Participants cited ease of use and not having to leave home as positive aspects, and transportation and mailing issues as negative aspects of home-based testing. CONCLUSIONS: CHW support led to higher COVID-19 test completion rates, particularly among older adults. Significant testing barriers included language, educational level, rurality, and test kit issues.

An agricultural community's perspectives on COVID-19 testing to support safe school reopening.

Introduction: School-based COVID-19 testing may be an effective strategy for reducing transmission in schools and keeping schools open. The study objective was to examine community perspectives on school-based COVID-19 testing as a mitigation strategy to support safe school reopening. Methods: We conducted a qualitative study in Yakima County, an agricultural region of Washington state, where over half of residents are Hispanic/Latino. From June to July 2021, we interviewed 18 students (13 years old, on average) and 19 school employees, and conducted four focus groups (2 in Spanish, 2 in English) with 26 parents. We audio-recorded the semi-structured interviews and focus group discussions which were then transcribed. We used an inductive, constant comparison approach to code the transcripts and conducted a thematic analysis to generate themes. Results: We identified four main themes. Students, parents, and school employees desired a return to in-person learning (Theme 1). Schools implemented numerous COVID-19 mitigation strategies (e.g., masking) to facilitate a safe return to school but felt that adding testing would not be feasible due to a lack of resources and overworked staff (Theme 2). Parents and school employees' familiarity with COVID-19 testing procedures influenced their support for testing (Theme 3). Parents and school employees felt there were inadequate resources for individuals who test positive for COVID-19 (Theme 4). Discussion: Schools require adequate resources and medical personnel to implement COVID-19 testing. Individuals also need resources after testing positive, including physical space to isolate, financial resources for those without paid time off, and delivery of food and other necessities to households in rural communities.

Factors influencing COVID-19 testing among Native Americans and Latinos in two rural agricultural communities: a qualitative study.

Objective: To examine factors influencing decisions to test for COVID-19 among Native Americans on the Flathead Reservation in Montana and the Latino community in the Yakima Valley of Washington state. Methods: We conducted 30 key informant interviews with community leaders and six focus groups with community members to examine factors impacting decisions to test for COVID-19 during the second year of the COVID-19 pandemic from May 2021 to June 2021. Results: Three major themes that impacted testing for COVID-19 were identified: (1) Social factors, including the influence of families and friends and employment practices; (2) health factors, including testing procedures, home-based testing, and health communication; and (3) contextual factors, including distrust for government and medical communities and the impact on cultural practices and celebrations. Conclusions: Social, health, and contextual factors influence the decision to test for COVID-19. Understanding the community's perception is critical for successful implementation of preventive strategies.

A pragmatic randomized trial of home-based testing for COVID-19 in rural Native American and Latino communities: Protocol for the "Protecting our Communities" study.

BACKGROUND: Home-based testing for COVID-19 has potential to reduce existing health care disparities among underserved populations in the United States. However, implementation of home-based tests in these communities may face significant barriers. This study evaluates the acceptability, feasibility, and success of home-based testing and the potential added benefit of active support from trusted community health workers for Native Americans and Hispanic/Latino adults living in rural Montana and Washington states. METHODS/DESIGN: The academic-community research team designed the trial to be responsive to community needs for understanding barriers and supports to home-based COVID-19 testing. The "Protecting Our Community" study is a two-arm pragmatic randomized controlled trial in which a total of 400 participants are randomized to active or passive arms. Participants of both study arms receive a commercially available home collection COVID-19 test kit, which is completed by mailing a self-collected nasal swab to a central laboratory. The primary study outcome is return of the kit to the central lab within 14 days. The cultural, social, behavioral, and economic barriers to home-based COVID-19 testing are also assessed by qualitative research methods. A survey and semi-structured interviews are conducted after the trial to evaluate perceptions and experience of home-based testing. DISCUSSION: Implementing home-based testing in underserved populations, including among Native American and Hispanic/Latino communities, may require additional support to be successful. The Protecting Our Community trial examines the effect of trusted community health workers on use of home-based testing, which may be adaptable for community-driven models of home-based testing in other underserved populations.

Anorectal melanoma: report of three cases with extended follow-up.

Primary anorectal melanoma is rare. There is controversy regarding the best surgical treatment because of its poor prognosis. Three cases with extended follow-up are reported in this article. A 53-year-old woman with rectal bleeding was diagnosed with a melanoma of the rectum and underwent an abdominoperineal resection. The patient died with distant metastases 8 months later. An 80-year-old woman with rectal bleeding was diagnosed with a melanoma of the rectum and underwent a transanal local excision. She remains alive 4 years later but with locally recurrent disease. A 78-year-old man with rectal bleeding was diagnosed with a melanoma of the rectum and underwent an abdominoperineal resection. He died with local and metastatic disease 25 months later. Recent trends favor local excision when technically feasible, although some patients may require an abdominoperineal resection of the rectum, especially for larger tumors.

Posibilidades quirúrgicas en los pacientes con adenocarcinoma del páncreas / Surgical options in pancreatic adenocarcinoma

Conocer el tipo de procedimientos quirúrgicos, y sus resultados, realizados en pacientes con adenocarcinoma del páncreas. Antecedentes. Hasta antes de 1980, los reportes de la literatura mostraban que la frecuencia de excisión de tumores pancreáticos era muy baja, con morbimortalidad elevada y una supervivencia a 5 años menor al 8 por ciento. Sin embargo, durante la última década estas cifras cambiaron radicalmente. Aunque la cirugía paliativa sigue predominando, posee bajas expectativas. Métodos. Se revisaron retrospectivamente los expedientes de todos los pacientes que fueron sometidos a algún tipo de cirugía entre 1962 y 1991, en relación con la presencia de adenocarcinoma del páncreas. Se analizaron características demográficas , tipos de operación, morbimortalidad quirúrgica y los resultados a largo plazo. Resultados. Se reunieron 410 pacientes, correspondiendo el 52 por ciento al sexo masculino y el 48 por ciento al femenino. Sólo en el 20 por ciento se pudo efectuar la excisión de la neoplasia, predominando la pancreatoduodenectomía en un poco más de 2/3 partes de los pacientes. En el 80 por ciento restantes se efectuaron procedimientos paliativos (73 por ciento) y diagnósticos (27 por ciento). En el grupo con excisión del tumor, la pancreatectomía total presentó la mayor morbimortalidad, y aunque la pancreatectomía distal y la pancreatoduodenectomía mostraron cifras menores, éstas no fueron depreciables. La supervivencia a 5 años fue del 8 por ciento, correspondiendo el 4 por ciento a la pancreatoduodenectomía. En los procedimientos paliativos, ningún paciente vivió más de 20 meses. Más del 95 por ciento falleció antes de los 12 meses. Conclusiones. Hasta la fecha de cortes para el análisis, nuestro grupo mostró las mismas características señaladas por la literatura mundial hasta 1985, en cuanto a posibilidades de realizar cirugía con fines "curativos", frecuencia de intervenciones paliativas, morbimortalidad quirúrgica y supervivencia a largo plazo. Será necesario esperar el análisis de los pacientes operados en la siguiente década, con el fin de conocer si en nuestro medio continúa la misma tendencia informada por la literatura

Cardiomiotomía de Heller modificada por vía laparoscópica / Modified laparoscopic Heller's cardiomyotomy

Se analizaron prospectivamente las características clínicas, forma de diagnóstico, detalles de la intervención, desarrollo de complicaciones y resultados, de seis pacientes intervenidos quirúrgicamente por acalasia, mediante Cardiomiotomía laparoscópica, en el Instituto Nacional de la Nutrición entre 1995-1996. Cuatro fueron hombres y dos mujeres, con una edad promedio de 34 ñ 11 años. Todos cursaban con disfagia y regurgitaciones, con un tiempo promedio de evolución de nueve años. A todos los enfermos se les practicó Cardiomiotomía de por lo menos 5 cm con hemifunduplicación. En un paciente hubo ruptura accidental de la mucosa esofágica durante el procedimiento, que se suturó por la misma vía, y otro desarrolló neumonía segmentaria durante el postoperatorio inmediato. La estancia hospitalaria postoperatoria fue en promedio de 6 ñ 2 días. A un promedio de seguimiento de 9 ñ 5 meses, dos pacientes se encuentran completamente asintomáticos, y cuatro cursan con síntomas mínimos ocasionales

Cáncer de duodeno / Duodenal cancer

Analizar las características generales y evolución de una cohorte de 6 pacientes con tumores malignos del duodeno, tratados mediante cirugía radical. Diseño: Estudio longitudinal retrolectivo. Lugar: Centro de atención hospitalaria de tercer nivel. Resultados: La edad promedio fue de 48 años y la relación de sexo H/M de 2:1. Los síntomas obstructivos fueron frecuentes. El tiempo promedio de evolución del cuadro clínico fue de 15 meses. Cinco de los seis pacientes demostraron anormalidad en la serie gastroduodenal. A todos se les efectuó operación de Whipple, siendo curativa en dos casos, paliativa en dos más y no evaluable en los dos restantes por mortalidad operatoria; cinco tumores correspondieron a adenocarcinomas y el otro fue un tumor carcinoide. La mortalidad a largo plazo ocurrió en dos pacientes. Conclusiones: El diagnóstico del adenocarcinoma duodenal requiere de una alta sospecha clínica. Su tratamiento mediante cirugía radical permite sobrevida prolongada

Siete casos de carcinoma del colédoco distal / Seven cases of carcinoma of the distal common bile duct

Se revisaron los expedientes clínicos de siete pacientes con carcinoma del tercio inferior del conducto biliar extrahepático en un período de 20 años. Se analizaron las características clínicas, laboratoriales, hallazgos transoperatorios, histopatológicos y evolución. Cuatro pacientes fueron del sexo masculino y tres del femenino. La edad promedio fue 59 años (intervalo 53 a 68). A todos se les detectó ictericia, dolor abdominal y pérdida de peso. Los niveles de bilirrubina total fueron superiores a 5 mg/dL en seis pacientes (86 por ciento). La colangiografía endoscópica fue el método diagnóstico más utilizado. A todos se les realizó la operación de Whipple. No hubo mortalidad operatoria. En el seguimiento se perdieron tres pacientes sin evidencia de enfermedad y los restantes fallecieron; en tres se detectó recidiva del tumor (43 por ciento). La recidiva local del carcinoma del conducto biliar fue alta, aun después de cirugía con intento curativo

Carcinoma de páncreas / Pancreatic carcinoma

Durante el período comprendido entre 1960 y 1992, se practicó cirugía radical a 33 pacientes con adenocarcinoma de páncreas en el Instituto Nacional de Nutrición "Salvador Zubirán". Los hallazgos clínicos más significativos fueron ictericia en 88/100 vesícula palpable en 76/100 y pérdida de peso en 58/100. En 23 pacientes se practicó pancreaticoduodenectomía (70/100) y en 10 pancreatectomía total (30/100). La morbimortalidad operatoria fue de 24/100 y 36/100 respectivamente. Se administró tratamiento adyuvante a base de radio y/o quimioterapia a 11 pacientes. La supervivencia a 12 y 15 meses de 36/100 y 14/100 demostrándose recidiva tumoral en ocho pacientes (24/100). No hubo sobrevivientes a 5 años. Concluimos que el adenocarcinoma que el adenocarcinoma pancreático es una enfermedad letal con pronóstico pobre a pesar de su excisión quirúrgica radical

Pancreatoduodenoctomía en el tratamiento de carcinoma del ámpula de Vater / Pancreatoduodenectomy in ampullary carcinoma

Objetivo: Analizar las características clínicas, estudios diagnósticos, hallazgos transoperatorios, morbimortalidad y evolución de una serie de pacientes con adenocarcinoma del ámpula de Vater. Diseño. Estudio retrospectivo. Lugar. Centro de tercer nivel de atención médica. Pacientes. 34 pacientes consecutivos tratados mediante cirugía radical entre 1960 y 1992. Resultados. Los hallazgos clínicos más frecuentes fueron: ictericia (91 por ciento), pérdida de peso (44 por ciento) y vesícula palpable (42 por ciento. Se practicó pancreatoduodenectomía a 33 enfermos (97 por ciento) y pancreatectomía total a uno (3 por ciento). La mortalidad operatoria fue del 15 por ciento. La supervivencia al año, 5, 10 y 14 años fueron 67 por ciento, 36 por ciento, 25 por ciento y 17 por ciento, respectivamente. Catorce pacientes fallecieron por recidiva tumoral a más de cinco años de la intervención. Conclusiones. La resección quirúrgica radical del adenocarcinoma de ámpula de Vater permite sobrevidas prolongadas