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Pre-exposure prophylaxis (PrEP) decreases human immunodeficiency virus (HIV) acquisition among persons who inject drugs (PWID); however, its uptake has been suboptimal. We explored HIV risk perceptions and PrEP interest among drug detoxification center patients in the context of the ongoing opioid overdose epidemic. We conducted in-depth interviews of patients (

Las infecciones de piel y partes blandas (IPPB) en niños son una de las principales causas de prescripción de antimicrobianos. El objetivo del estudio fue describir las características clínicas y microbiológicas de las IPPB ambulatorias de niños asistidos en dos hospitales zonales. Se realizó un estudio prospectivo entre 1/11/2017 y 1/11/2018. Se incluyeron pacientes entre 1 mes y 15 años, internados en dos hospitales. Se evaluó: edad, sexo, localidad, factores predisponentes, tipo de IPPB, muestras biológicas realizadas, aislamiento microbiológico, tratamiento empírico indicado y evolución del cuadro. Se realizó antibiograma y determinación genética. Se calculó chi2, IC95, OR; α=5%. N= 94. 58,7% masculinos. 12 pacientes 1 año (promedio de edad 4 años, 1-15). El 36% de Tandil y 63,8% de Florencio Varela. El 59,6% corresponden a IPPB purulentas. El rédito diagnóstico fue de 59,6%. Los aislamientos principales: SAMR (40,4%), SAMS (7,4%), S. agalactiae (2,1%) y S. pyogenes (2,1%). El 100% de SAMR son portadores de gen mecA y SCCmec tipo IV, sin multirresistencia. No hubo diferencia estadística entre los factores de riesgo evaluados. El 52,1% de los niños recibió tratamiento antibiótico combinado, siendo la más indicada TMS-SMX + CLI en 36 eventos. (38,3%). La evolución fue favorable ambos grupos: no hubo diferencia significativa entre el subgrupo que se aisló SAMR y el subgrupo que no se aisló SAMR; 91,9% (34/37) y 92,6% (50/54) correspondientemente (chi2: 0,01; p= 0,97 IC95: 0,26-3,88). El principal agente etiológico fue SAMRco, debiendo adecuar los tratamientos a este microorganismo.

CONTEXT Racial/ethnic inequities are well documented in both maternal-infant health and substance use disorder treatment outcomes. OBJECTIVE To systematically review research on maternal-infant dyads affected by opioid use disorder (OUD) to evaluate for racial/ethnic disparities in health utilization or outcomes and critically assess the reporting and inclusion of race/ethnicity data. DATA SOURCES Peer-reviewed literature in MEDLINE, Embase, and Web of Science from 2000 to 2020. STUDY SELECTION Research reporting health utilization and outcomes data on dyads affected by OUD during pregnancy through the infant’s first birthday. DATA EXTRACTION We extracted data on race/ethnicity, study exposures/outcomes, how race/ethnicity data were analyzed, how authors discussed findings associated with race/ethnicity, and whether racism was mentioned as an explanation for findings. RESULTS Of 2023 articles reviewed, 152 quantitative and 17 qualitative studies were included. Among quantitative studies, 66% examined infant outcomes (n = 101). Three articles explicitly focused on evaluating racial/ethnic differences among dyads. Among quantitative studies, 112 mentioned race/ethnicity, 63 performed analyses assessing for differences between exposure groups, 27 identified racial/ethnic differences, 22 adjusted outcomes for race/ethnicity in multivariable analyses, and 11 presented adjusted models stratified by race/ethnicity. None of the qualitative studies addressed the role that race, ethnicity, or racism may have had on the presented themes. CONCLUSIONS Few studies were designed to evaluate racial/ethnic inequities among maternal-infant dyads affected by OUD. Data on race/ethnicity have been poorly reported in this literature. To achieve health equity across perinatal OUD, researchers should prioritize the inclusion of marginalized groups to better address the role that structural racism plays.

Access to and uptake of evidence-based treatment for substance use disorder, specifically opioid use disorder (OUD), are limited despite the high death toll from drug overdose in the United States in recent years. Patient perceived barriers to evidence-based treatment after completion of short-term inpatient medically managed withdrawal programs (detox) have not been well studied. The purpose of the current study is to elicit patients' perspectives on challenges to transition to treatment, including medications for OUD (MOUD), after detox and potential solutions.We conducted semi-structured interviews (N = 24) at a detox center (2018-2019) to explore patients' perspectives on obstacles to treatment. The study managed the data in NVivo and we used content analysis to identify themes.Patients' characteristics included the following: 54 % male; mean age 37 years; self-identified as White 67 %, Black 13 %, Latinx 8 %, Native Hawaiian/Pacific Islander 4 %, and other 8 %; heroin use in the past 3 months 67 %; and ever injecting drugs 71 %. Patients identified the following barriers: 1) lack of continuity of care; 2) limited number of detox and residential treatment program beds; 3) unstable housing; and 4) lack of options when choosing a treatment pathway. Solutions proposed by participants included: 1) increase low-barrier access to community MOUD; 2) add case managers at the detox center to establish continuity of care after discharge; 3) increase assistance with housing; and 4) encourage patient participation in treatment decisions.Patients identified lack of continuity of care, especially care coordination, as a major barrier to substance use treatment. Increasing treatment utilization, including MOUD, necessitates a multimodal approach to continuity of care, low-barrier access to MOUD, and support to address unstable housing. Patients want care that incorporates options and respect for. individualized preferences and needs.

Una de las variables para medir la calidad de vida de las personas que viven con el virus de inmunodeficiencia humana (VIH) es el trabajo. El objetivo de este estudio fue comparar, discriminando por género, la situación laboral de personas que viven con VIH en Buenos Aires, Argentina. Es un estudio comparativo realizado en tres hospitales entre abril y julio de 2015. Se evaluó: rango de edad, género, tratamiento antirretroviral, carga viral, personas a cargo, autopercepción del estado de salud, nivel educativo, situación laboral, acceso a beneficio social, comparación entre ingresos con el salario mínimo, oficio. α=5% a dos colas. Se realizó test de Mann-Whitney-Wilcoxon y Fisher. Se realizaron 82 encuestas. Un 87,2% tenían entre 20 y 59 años; relación hombre (H)/mujer (M): 1/1; el 84,1% bajo tratamiento antirretroviral y 67,1% tenían carga viral indetectable. El 54,9% con personas a su cargo. La mediana de autopercepción de salud fue de 7,94, sin diferencias entre el sexo (p=0,35). El 48,8% de los H y 50% de las M tuvieron como máximo 7 años de educación formal. El 17,1% de los H y 7,5% de las M se encontraban desocupadas (p=0,03); trabajo informal en 65,8% de H y 37,5% de las M, pero el 47,5% de las M son amas de casa. El 32,9% de las personas no reciben beneficio social, 20% de M y 43,9% de H (p=0,03). El ingreso de las personas correspondió al 64,8% del salario mínimo. La situación económica del país cambió, queda ver si la situación laboral también lo hizo.

Staphylococcus aureus meticilina-resistente (SAMR) es una causa frecuente de bacteriemias intrahospitalarias. Para su tratamiento se utiliza vancomicina y han emergido cepas con sensibilidad disminuida heterogénea (h-VISA) que albergan subpoblaciones con sensibilidad reducida a vancomicina. Se comunica un caso de bacteriemia intra-tratamiento con vancomicina por SAMR h-VISA. El aislamiento muestra sensibilidad a vancomicina (CIMvan: 1 μg/mL), sin embargo E-test GRD sugiere h-VISA (CIMvan: 2 μg/mL y CIMtei: 8 μg/mL). El análisis del perfil poblacional - área bajo la curva (PAP-AUC) valida este hallazgo. Se rota a linezolid con resolución clínica.

Objective: To evaluate the effect of a multi-component intervention including communication training on provider beliefs and recommendation practices around the human papillomavirus (HPV) vaccine using both self-reports and audio-recordings of clinical interactions. Methods: We conducted a mixed method study at five family medicine and pediatric practices. Providers self-reported beliefs and practices about HPV vaccination via surveys and qualitative interviews conducted pre- and post-intervention. We also assessed provider recommendation style using audio-recordings of clinical interactions pre- and post-intervention. Content analysis was used to identify themes in qualitative interviews. Matched pre- and post-intervention surveys were analyzed for changes in provider beliefs and attitudes. Pre- and post-intervention audio recordings of clinical interactions were analyzed for observed differences in recommendation styles. Bivariate analyses of quantitative data used Chi-square and Fisher’s exact tests; t-tests were used for continuous variables. Results: Providers reported in interviews that the intervention led to communication changes by increasing their knowledge, reframing the HPV vaccine as a routine vaccination, and providing tools for engaging with parents. Surveys indicated that the proportion of providers reporting that the HPV vaccine is one of the most important adolescent vaccines increased from 71% pre-intervention to 100% post-intervention (p = .03). Audio-recording analysis demonstrated that use of an indicated (presumptive) recommendation style increased from 62.5% pre-intervention to 79.6% post-intervention (p = .047). Conclusions: Educating providers about HPV vaccination and giving them tools to facilitate communication with parents can reframe HPV as a routine adolescent vaccination and motivate providers to routinely use effective recommendation styles in practice.

Los objetivos del presente estudio fueron: evaluar la CVRS en personas que viven con VIH/SIDA, relacionar la calidad de vida con variables sociológicas, clínicas e inmunológicas, caracterizar el perfil socioepidemiológico de la población que vive con VIH/SIDA, identificar las adicciones y comorbilidades que se presentan en dicha población, conocer el grado de inmunosupresión determinado por el recuento de LT CD4+ y de la carga viral plasmática, conocer el tipo, ocurrencia y distribución de enfermedades marcadoras de SIDA que presentan los pacientes durante la evolución de su enfermedad, estimar la prevalencia de hospitalización en la población de pacientes, conocer los aspectos más relevantes del tratamiento antiretroviral que realizan los pacientes y establecer la relación entre variables sociológicas, clínicas e inmunológicas y la puntuación obtenida en las dimensiones que integran el cuestionario de salud SF-36., Facultad de Ciencias Médicas

Enterococci often acquire antimicrobial resistance through horizontal gene transfer. Relatedness between enterococci with high level resistance to gentamicin and vancomycin isolated from humans, food and hospital environment in Tandil County (Argentina) was investigated. PCR amplification for species determination was carried out. Resistance to seven antimicrobials was studied; virulence genes (esp, cylA), vancomycin and gentamicin resistance genes were investigated. In the isolates with high level antimicrobial resistance (gentamicin, vancomycin), pulse-field gel electrophoresis was performed. Vancomycin-resistant E. faecium (n:13) were recovered from human, food and hospital environment samples. All the isolates expressed high-level vancomycin and teicoplanin (vanA genotype), as well high-level gentamicin and streptomycin resistance. Vancomycin-resistant E. faecium were distributed among seven clonal types; esp gene was detected in clinical strains. There was no clonal relationship with food vanA E. faecium, but these strains could pose a risk in intra/inter genus transfer of vanA determinant to human-adapted strains. High-level gentamicin resistant E. faecalis (n:7) were recovered from human and food samples. Glycopeptide resistance was not observed; cylA gene was detected in most of the clinical high-level gentamicin resistant E. faecalis isolates. PFGE patterns showed four clonal types in high-level gentamicin resistant E. faecalis strains; there was demonstrated clonal relatedness between isolates from different origin. In Argentina, this is the first study showing a clonal relationship between high-level gentamicin resistant E. faecalis isolated from food and humans. These results encourage the study of dissemination of clonal complexes with mobile resistance genes., Facultad de Ciencias Médicas

Objectives Gestational diabetes mellitus (GDM) greatly increases the risk of developing diabetes in the decade after delivery, but few women receive appropriately timed postpartum glucose testing (PPGT) or a referral to primary care (PC) for continued monitoring. This qualitative study was designed to identify barriers and facilitators to testing and referral from patient and providers' perspectives. Methods We interviewed patients and clinicians in depth about knowledge, values, priorities, challenges, and recommendations for increasing PPGT rates and PC linkage. Interviews were coded with NVIVO data analysis software, and analyzed using an implementation science framework. Results Women reported motivation to address GDM for the health of the fetus. Most women did not anticipate future diabetes for themselves, and focused on delivery outcomes rather than future health risks. Patients sought and received reassurance from clinicians, and were unlikely to discuss early onset following GDM or preventive measures. PPGT barriers described by patients included provider not mentioning the test or setting it up, transportation difficulties, work responsibilities, fatigue, concerns about fasting while breastfeeding, and timing of the test after discharge from obstetrics, and no referral to PC for follow-up. Practitioners described limited communication among multiple care providers during pregnancy and delivery, systems issues, and separation of obstetrics from PC. Conclusions Patients' barriers to PPGT included low motivation for self-care, structural obstacles, and competing priorities. Providers reported the need to balance risk with reassurance, and identified systems failures related to test timing, limitations of electronic medical record systems (EMR), lack of referrals to PC, and inadequate communication between specialties. Prevention of early onset has great potential for medical cost savings and improvements in quality of life.

Material and methods Adults presenting to a hospital-based primary care clinic with recent drug use (Alcohol, Smoking and Substance Involvement Screening Test [ASSIST] drug specific scores of ?4) were enrolled in a randomized clinical trial comparing: (1) a 10-15 minute structured interview conducted by health educators (BNI), (2) a 30-45 minute intervention based on motivational interviewing by Masters-level counselors (MOTIV), or 3) no brief intervention. All received information on treatment resources. We assessed receipt of any SUD treatment in a statewide database. Logistic regression analyses adjusted for main drug (self-identified), drug dependence, and past SUD treatment.

The hypothesis that there is a constellation of qualities that predisposes certain children to be chronically victimized is supported by three forms of evidence. First, children who are victims have qualities in common that differentiate them from other children. Some of these qualities exist before the child is victimized; others develop because of the victimization. Second, children who are victimized early in life remain victims for a long period of time, even though the bullies and situations may differ. Third, other children are able to identify potential victims with high reliability. To clarify why these victims are chronically harassed, this article examines qualities of victims, bullies, and the environment that support bully/victim problems.

This essay reflects on the experience of mentoring undergraduate research on a Swedish practicum in childhood, family and social policy in Sweden from the perspective of the faculty advisor.

The paper examines professional commitment among physicians who immigrated to Israel from the former Soviet Union during the early 1990s. This population faces severe limits regarding occupational continuity because of the highly saturated market in which non-negligible groups will, in the long run, of necessity undergo occupational change. The theoretical background for the analysis is drawn from the literature regarding recent changes in professional roles with particular reference to the shifting meaning of work in post-modern societies and its consequences for occupational commitment. The professional context of medical practice in the former Soviet Union and the social and economic constraints of Israeli society in the 1990s set the scene for the analysis. Several dimensions of professional commitment are examined empirically, on the assumption that there are a variety of ways to consider the notion of commitment and that no one measure tells a complete story. Prolonged processes of depressionalization of medicine in the Soviet Union, suggest that medicine for most immigrant physicians is not so much a ‘calling’ to which they are devoted; rather it is a necessary means to gain a livelihood, the only occupation for which they have been trained for many years after stringent selection to medical school and the only job in which they have worked consistently since completing their formal training. Two and a half years after arrival in Israel the immigrant doctors are characterized by a short-range time perspective which makes them unwilling to accept the constraints of the saturated market; intense efforts are made by most to obtain a license despite the fact that only a fraction of them will be able to work in their profession on a regular basis. Despite this over-riding reality, many hope that they will be among the selected few who will be able to obtain a medical post.

This paper is a case study of a year-long psychodynamic therapy group for inner-city, traumatized, latency-age boys in which the originating treatment approach was analytic and interpretive. The purpose of the paper is to illustrate and examine group processes, therapists' responses, and the challenges of utilizing psychodynamic group treatment with these youngsters. Following descriptions of the setting, treatment structure, and population, developments in the group are depicted and then discussed utilizing relevant literature. In particular the thrust towards an action-oriented, here-and-now group experience is considered along with influences shaping the use of verbal interpretation and interaction within the group.

Enterococci are part of the indigenous microbiota of human gastrointestinal tract and food of animal origin. Enterococci inhabiting non-human reservoirs play a critical role in the acquisition and dissemination of antimicrobial resistance determinants. The aim of this work was to investigate the antimicrobial resistance in Enterococcus faecalis and Enterococcus faecium strains recovered from artisanal food of animal origin. Samples of goat cheese (n = 42), cow cheese (n = 40), artisanal salami (n = 30), and minced meat for the manufacture of hamburgers (n = 60) were analyzed. Phenotypic and genotypic tests for species-level identification of the recovered isolates were carried out. Minimum inhibitory concentration (MIC) study for in vitro quantitative antimicrobial resistance assessment was performed, and 71 E. faecalis and 22 E. faecium were isolated. The recovered enterococci showed different multi-drug resistance patterns that included tretracycline, erythromycin, ciprofloxacin, linezolid, penicillin, ampicillin, vancomycin, teicoplanin, gentamicin (high-level resistance), and streptomycin (high-level resistance). VanA-type E. faecium were detected. β-lactamase activity was not observed. Artisanal foods of animal origin act as a non-human reservoir of E. faecalis and E. faecuim strains, expressing multi-resistance to antimicrobials. In conclusion, the implementation of a continuous antimicrobial resistance surveillance in enterococci isolated from artisanal food of animal origin is important.

Reductions in control group consumption over time that are possibly related to research design affect the impact of brief alcohol interventions (BAI) in clinical settings.We conducted a systematic review to identify research design factors that may contribute to control group change, strategies to limit these effects and implications for researchers. Studies with control group n30 were selected if they published baseline and outcome consumption data, conducted trials in clinical settings in Anglophone countries and did not censor gender or age.Among 38 studies cited in 20 reviews through October 2009, 16 met criteria (n = 31-370). In 54%, controls received alcohol specific handouts, advice and/or referral. Both the number and depth of assessments were highly variable. The percentage change in consumption ranged from-0.10 to-0.84 (mean-0.32), and effect size from 0.04 to 0.70 (mean 0.37). Published data were insufficient for meta-analysis.Researchers should consider strategies to reduce the impact of research design factors, such as procedures to enhance sample diversity, blind subjects to study purpose to limit social desirability bias, reduce the number and depth of instruments (assessment reactivity), and finally, analytic techniques to decrease the impact of outliers and regression to the mean.This review identifies problems with retrospective analysis of predictors of control group change, and underscores the need to design prospective studies to permit identification, quantification and adjustment for potential sources of bias in BAI trials.

This paper reports the findings of a study of nonconventional medicine in Israel. Data regarding patterns and correlates of consultations with alternative medicine practitioners were obtained from structured face-to-face interviews with a representative sample of 2030 Jewish adults aged 45 to 75. In addition, in-depth open-ended interviews were conducted with a convenience sample of 20 primary care physicians in order to explore their beliefs, attitudes and behaviors regarding nonconventional medicine. Six percent of the respondents interviewed in the population study visited an alternative practitioner in the year prior to the interview. For most of them, the consultation was a consequence of disappointment with the lack of success of conventional medical treatment. Most felt that the alternative medicine treatment had helped. Nearly 40% were seeing their regular primary care physician at the same time as they were seeing an alternative medical practitioner. Women were more likely than men to consult an alternative medicine practitioner; consulters rated their health status more negatively than non-consulters. Consulters had a higher level of education than non-consulters, but the two groups did not differ in terms of age or economic status. Nearly all of the physicians stated that they refer patients to alternative practioners; in most cases, the referrals are in response to patients' requests. Although skeptical of the scientific basis of alternative medicine therapies, most of the physicians believed that some therapies, even if only because of the “placebo effect”, were effective in some cases. Almost all felt that the Ministry of Health, which today does not recognize any form of alternative medicine, should establish control over the training and practice of alternative medical practitioners. The findings from both parts of the study suggest that patients and primary care physicians in Israel do not view nonconventional medicine as a threat to conventional medicine, but rather as complementary to it.

This study is a retrospective evaluation of the Soviet health care system by 1,100 Jewish physicians who immigrated to Israel in 1990, but were professionally active in the former Soviet Union before and during the Gorbachev era. Medical education and the process of specialization; gender differences within the medical profession; sources of work satisfaction and dissatisfaction; self-evaluations of professional behavior; and assessments of patient behavior are included in this empirical study. Although high levels of dissatisfaction were found regarding instrumental aspects of work, the physicians reported high levels of satisfaction with their relationships with colleagues and patients. The recent emigrants assessed their own role behavior and that of their patients more critically than did physicians who left the Soviet Union in 1972, and who answered identical questions in 1975. Among the recent emigrants, men, older physicians, and those with higher status within the profession tended to be more satisfied with their work and less critical about their own and their patients' behavior than their female, younger and lower status colleagues. The subjective perceptions of former "insiders," which complement the reports that have appeared in recent years in the medical literature, are discussed in terms of the impact of glasnost and perestroika on reporting behavior and on the real deterioration that occurred in the health care system of the former Soviet Union.

Material and methods We randomly assigned participants identified by screening with Alcohol Smoking and Substance Involvement Screening Test (ASSIST) drug specific scores of 2 or 3 (consistent with low risk drug use) to: no BI, a brief negotiated interview (BNI), or an adaptation of motivational interviewing (MOTIV). BNI was a 10-15 minute structured interview conducted by health educators. MOTIV was ?45 minutes with an optional booster conducted by trained master’s-level counselors. Primary outcome was number of days use of self-identified main drug in the past 30 as determined by validated calendar method at 6 months. Analyses were performed using negative binomial regression adjusted for baseline use and main drug.