Steroids and mortality in non-critically ill COVID-19 patients: a propensity score-weighted study in a Chilean cohort.

OBJECTIVES: The aim of this study was to evaluate the impact on 30-day mortality of early use of corticosteroids in COVID-19 patients with supplementary oxygen requirements and without invasive mechanical ventilation at the initiation of therapy. METHODS: All patients hospitalized with COVID-19 between April 15 and July 15, 2020, and requiring supplementary oxygen, were prospectively included in a database. Patients who died or required intubation within the first 48 hours were excluded. Patients who received corticosteroids within the first 5 days of hospitalization and at least 24 hours prior to intubation were allocated to the 'early corticosteroids' group. To compare both populations and adjust for non-random treatment assignment bias, a weight-adjusted propensity score model was used. RESULTS: In total, 571 patients met the inclusion criteria, 520 had sufficient information for the analysis. Of these, 233 received early corticosteroids and 287 did not. Analysis showed a reduction of 8.5% (p = 0.038) in 30-day mortality in the early corticosteroid group. The reduction in mortality was not significant when patients with corticosteroid initiation between day 5 and day 8 of hospitalization were included. CONCLUSION: Early corticosteroid use reduced mortality in patients with pneumonia due to COVID-19, who required supplementary oxygen but not initial invasive mechanical ventilation.

Habilidades comunicativas en la persona del terapeuta: una nueva línea educativa en la formación de fonoaudiólogas y fonoaudiólogos de la Universidad de Chile / Communication skills in the person of the therapist: a new educational approach in the training of speech and language therapists and audiologists at the University of Chile

Los académicos del Departamento de Fonoaudiología de la Universidad de Chile manifiestan una constante preocupación por mejorar la calidad de la educación profesional de sus estudiantes. Por ello, en el marco de la innovación curricular, han implementado dentro de la malla innovada una línea de trabajo para el desarrollo personal y profesional de habilidades comunicativas no verbales y verbales, en modalidad oral y escrita. En este artículo, se expone la fundamentación que sustenta la propuesta metodológica de dicha línea y su puesta en práctica. Además, se informa la fase en la que se encuentra la implementación de la propuesta y se comenta la necesidad de su evaluación.

Faculty in the Department of Communication Sciences and Disorders at the University of Chile constantly seeks to improve the quality of undergraduate education. In this regard, as part of a curriculum innovation process, a new educational curriculum was designed that includes an academic path aimed at developing personal and professional verbal and nonCverbal communication skills both in spoken and written modes of communication. This paper presents the rationale behind the design and implementation of this new academic path. Furthermore, an analysis of the current status of the implementation, which includes an evaluation of this process, is presented.

Differential item functioning in a Spanish translation of the Beck Depression Inventory.

Brief and culturally compatible measures of depression are necessary, yet most depression scales are translated without regard for cultural biases. In this study, 292 medical outpatients completed an English or a Spanish-translated and back-translated version of the Beck Depression Inventory (BDI). The BDI items were analyzed for bias between Spanish and English-speaking patients to determine the equivalence of the scale. A Differential Item Function (DIF) using a Mantel Haenszel Approach for Ordered Response Categories was used to analyze how likely subjects in the two ethnic groups were to endorse each response category. The results suggest that regardless of level of depression, Latinos are more likely to endorse items reflecting tearfulness and punishment, and less likely to endorse inability to work. Cultural interpretations and recommendations for use of the BDI are discussed.

The effects of clinical case management on hospital service use among ED frequent users.

This study examined the impact of case management on hospital service use, hospital costs, homelessness, substance abuse, and psychosocial problems in frequent users of a public urban emergency department (ED). Subjects were 53 patients who used the ED five times or more in 12 months. Utilization, cost, and psychosocial variables were compared 12 months before and after the intervention. The median number of ED visits decreased from 15 to 9 (P < .01), median ED costs decreased from $4,124 to $2,195 (P < .01) and median medical inpatient costs decreased from $8,330 to $2,786 (P < .01). Homelessness decreased by -57% (P < .01), alcohol use by -22% (P = .05) and drug use by -26% (P = .05). Linkage to primary care increased 74% (P < .01). Fifty-four percent of medically indigent subjects obtained Medicaid (P < .01). There was a net cost savings, with each dollar invested in the program yielding a $1.44 reduction in hospital costs. Thus, case management appears to be a cost-effective means of decreasing acute hospital service use and psychosocial problems among frequent ED users.

Self-recognition of depression in public care women's clinic patients.

Because young women seen in public care gynecology clinics are at very high risk for depression, it is important to find ways to increase detection of depression in this patient population. This study examined rates and predictors of self-recognition of depression in a sample of 95 depressed public care women's clinic patients. We found that fewer than half of the women (44%) identified their problems as depression, suggesting that the majority of women were not likely to receive treatment for their problems. Predictors of self-recognition included being told by a doctor in the past that they were depressed, endorsing medical/psychiatric causes of mental illness, and use of the coping strategies of facing a problem, alcohol or drug use, and prayer. These findings indicate the need for gynecology settings to (1) provide education about depression to women, (2) encourage them to discuss emotional problems with their physicians, and (3) provide increased education and training to physicians and staff about depression detection and assessment.

Distressed women's clinic patients: preferences for mental health treatments and perceived obstacles.

Women seen in public gynecology settings are at very high risk of developing psychiatric disorders. Because low-income and ethnic minority women seen in such settings underutilize mental health services, it is important to better understand treatment preferences and obstacles among this high-risk patient population. Public women's clinic patients (N = 105) who reported psychological or emotional distress were asked about their interest in medication, psychotherapy, and psychoeducational classes, as well as perceived obstacles to using these services. The vast majority were interested in receiving some form of mental health treatment, with the most interest shown for individual therapy and general psychoeducational classes about health and stress. Less interest was expressed in group therapy and medication. Women anticipated more instrumental barriers to using services, such as lack of money, transportation, and childcare, than stigma-related barriers, such as fear of embarrassment or rejection. However, Latinas, women with less education, and those with a current mood or anxiety disorder were more likely to anticipate stigma-related barriers to treatment than other women. Implications of these findings for referral and treatment of mental health problems among public women's clinic patients are discussed.

Unmet mental health needs of women in public-sector gynecologic clinics.

OBJECTIVE: We examined the mental health needs of poor young women seen in public-sector gynecologic settings. STUDY DESIGN: Participants were 205 ethnically diverse women, mean age 29 years, seen by gynecologists at San Francisco General Hospital, all either uninsured or receiving public medical assistance. An interview with an instrument designed to diagnose mood, anxiety, alcohol, and eating disorders in medical patients, the Prime-MD, was used to assess current mental disorders. Any history of sexual or other physical assault was recorded. Receipt of primary care was scored for comprehensiveness. RESULTS: The rates of current psychiatric disorders were extremely high; 21.5% had current major depression. The prevalence of anxiety disorders was also elevated among these women. Many had a history of sexual trauma, and 28% had been the victims of unwanted intercourse. Finally, many reported behaviors that pose serious health risks. For example, 32% smoked and 2% used illicit drugs. Fewer than half had access to comprehensive primary medical care. CONCLUSIONS: Young, poor women who seek care in public-sector gynecologic clinics would benefit from comprehensive medical care addressing their psychosocial needs.

Recruiting and retaining low-income Latinos in psychotherapy research.

This article offers suggestions for recruiting and retaining low-income Latinos in treatment studies. Because Latinos underuse traditional mental health services, places such as medical centers or churches with large Latino constituents are suggested as useful alternative sources. To keep Latinos in research protocols, providing culturally sensitive treatments are necessary. Culturally sensitive treatments should incorporate families as part of recruitment efforts, particularly older men in the family. In addition, showing respect is an important aspect of traditional Latino culture that includes using formal titles and taking time to listen carefully. Finally, traditional Latinos tend to like interactions with others that are more warm and personal than is generally part of a research atmosphere.

Demystifying the concept of ethnicity for psychotherapy researchers.

At a time when ethnic minority populations are increasing in the United States, few psychotherapy studies are including minorities in their samples. To include ethnic minorities in psychotherapy studies, the complex construct of ethnicity must be carefully measured. In this article, practical advice is offered for conceptualizing, measuring, and interpreting ethnic factors in psychotherapy studies. Also discussed are identifying pathways from ethnicity to psychotherapy outcomes. Pathways that may influence ethnic differences in psychotherapy outcome include cultural factors, minority status, socioeconomic status, acculturation, and immigration experiences.