A Qualitative Study of Primary Care Physicians' Experiences With Telemedicine During COVID-19.

BACKGROUND: Primary care practices rapidly adopted telemedicine visits because of the COVID-19 pandemic, but information on physician perspectives about these visits is lacking. METHODS: Fifteen semistructured interviews with practicing primary care physicians and physicians-in-training from a Southern California academic health system and group-model health maintenance organization were conducted to assess physician perspectives regarding the benefits and challenges of telemedicine. RESULTS: Physicians indicated that telemedicine improved patient access to care by providing greater convenience, although some expressed concern that certain groups of vulnerable patients were unable to navigate or did not possess the technology required to participate in telemedicine visits. Physicians noted that telemedicine visits offered more time for patient counseling, opportunities for better medication reconciliations, and the ability to see and evaluate patient home environments and connect with patient families. Challenges existed when visits required a physical examination. Physicians were very concerned about the loss of personal connections and touch, which they believed diminished expected rituals that typically strengthen physician-patient relationships. Physicians also observed that careful consideration to physician workflows may be needed to avoid physician burnout. CONCLUSIONS: Physicians reported that telemedicine visits offer new opportunities to improve the quality of patient care but noted changes to their interactions with patients. Many of these changes are positive, but it remains to be seen whether others such as lack of physical examination and loss of physical presence and touch adversely influence provider-patient communication, patient willingness to disclose concerns that may affect their care, and, ultimately, patient health outcomes.

Depressive symptoms are associated with higher morning plasma cortisol in primary care subjects.

BACKGROUND: Cortisol dysregulation has a potential role in depression. AIM AND METHODS: We evaluated depressive symptoms using the Hamilton Rating Scale for Depression in 48 primary care subjects without history of previous or current depression and its association with cortisol dysregulation (morning plasma cortisol, 24-hour urinary free cortisol and cortisol metabolites). Presence of metabolic syndrome and inflammatory parameters were also assessed. RESULTS: Hamilton Rating Scale for Depression correlated significantly with morning cortisol, but not with urinary free cortisol or metabolites. A significant increase in morning cortisol by Hamilton groups (asymptomatic ≤8; mild to moderate: 9-18; moderate to severe: ≥19) was observed even when adjusted by age/gender. We observed no association of depressive symptoms with metabolic or inflammatory parameters. CONCLUSION: Depressive symptoms in primary care subjects not consulting for their mood are associated with higher morning plasma cortisol, but not urinary cortisol or its metabolites. These observations suggest that systemic hypercortisolism and related metabolic disorders are not observed in mild/initial states of depressive disorders.

Description of internet addiction among Chilean medical students: a cross-sectional study.

OBJECTIVE: Internet addiction (IA) has been described as an emerging behavior related to the development of new technologies, with scarce studies on the subject and none involving medical students. The Internet Addiction Test (IAT) is a screening instrument used to detect IA worldwide, which was published in 1998 and inspired by the DSM-IV criteria for pathologic gambling. The objective of this study aims to measure the prevalence of IA in Chilean medical students and its possible association with demographic variables and depressive symptoms. METHODS: First- to fifth-year undergraduate medical students at a medical school in Santiago de Chile answered a self-administered survey that included demographic data, the IAT scale, and the Goldberg's General Health Questionnaire (GHQ-12) to screen for IA and depressive symptoms, respectively. RESULTS: Three hundred eighty-four students participated, achieving a response rate of 69.8 %, of which 11.5 % were classified as problematic users according to the IAT. The authors found a statistical association between positive results on the IAT and positive scores on the GHQ-12, as well as with the male gender. CONCLUSION: In this first study of IA in medical students, the authors found a rate of incidence similar to what has been published in the literature focusing on college students. Additionally, there was a positive association between emotional symptoms and other abuse behaviors.

Prevalence of molar-incisor hypomineralisation observed using transillumination in a group of children from Barcelona (Spain).

OBJECTIVES: The objectives were to investigate the prevalence of the condition, by using transillumination, in a group of children. Analysed the prevalence with regard to gender, jaw affected, and the teeth that exhibited dysplasia most commonly. METHODS: A sample of 550 children aged 6 to 14 years was selected at the Department of Paediatric Dentistry at the Universitat Internacional de Catalunya, but among those selected only 505 children were eligible for inclusion in the study. The gender and age of the child, number of permanent teeth, number of teeth affected by MIH and their position were registered. RESULTS: Ninety patients (17.85%) had MIH. Of these, 45 were girls (50%) and 45 were boys (50%). A total of 8062 permanent teeth were observed. Of these, 344 (4.2%) were affected by MIH. Of the teeth affected, 198 (57.7%) were located in the maxilla and 146 (42.4%) in the mandible. This result was statistically significant (P = 0.003). CONCLUSIONS: The population studied showed a prevalence of MIH of 17.8%. The presence of the defect did not differ according to sex in this population. Defects were more common among teeth in the maxilla.

Predictors of noncompliance to exercise training in heart failure.

BACKGROUND/OBJECTIVES: Exercise training is an emerging therapy in heart failure (HF). However, factors influencing noncompliance to exercise have not been evaluated. We assessed clinical factors, functional status, and emotional predictors of noncompliance to a 12-week home walking exercise program. METHODS: Using a correlational design, we evaluated noncompliance of 39 HF patients (aged 63.2 +/- 10.1 years, left ventricular ejection fraction 29.5% +/- 8.0%, peak oxygen consumption 14.1 +/- 3.7 mL/kg/min, HF duration 37.5 +/- 32.9 months, 74% New York Heart Association class II) to home walking exercise. Noncompliance was defined as (1) completion of the 12-week program with 60% or less of prescribed weekly walking duration (noncompliant completers); or (2) failure to complete the 12-week program (dropouts). Univariate analyses (chi-square or t test) and multivariate backward logistic regression were performed to identify clinical factors (body mass index, comorbidities, and HF duration), functional status (peak VO2), and emotional dysphoria (anxiety, hostility, depression) predictive of noncompliance to training. RESULTS: Mean compliance was 35% +/- 30% (945/2700 minutes) for noncompliant patients (n = 13) and 99% +/- 13% (2673/2700 minutes) for compliant patients (n = 26). In the multivariate analysis, higher comorbidity (odds ratio [OR]: 2.7, confidence interval [CI]: 1.11-6.71), longer HF duration (OR: 1.1, CI: 1.01-1.13), lower hostility (OR: 0.47, CI: 0.24-0.91), and lower body mass index (OR: 0.76, CI: 0.58-0.98) were predictive of noncompliance to exercise training in patients with HF. CONCLUSIONS: Noncompliance should be monitored carefully in HF patients with multiple comorbidities, longer HF duration, lower body mass index, and lower hostility scores. In this subgroup of HF patients, tailored exercise prescriptions may enhance compliance to an exercise program.

Separación de antígenos de fasciola hepática por cromatografía en gel

Se procedió al fraccionamiento de un extracto soluble de adultos de Fasciola hepatica median~f; una cromatografía en Sephadex G-200, obteniéndose 6 picos bien definidosy simétricos. Se obtuvieron 6 fracciones y de éstas, las 5 primeras resultaron antigénicas al ser enfrentads al antisuero de F hepatica mediante la técnica de contrainmunoelectroforesis (CIEF) y dieron resultados positivos frente al suero de pacientes con fascioliasis, en cambio no se, observó reacción positiva alguna frente a sueros humanós normales. Todas las fracciones, a excepción de los picos IV y V, presentaron reacciones cruzadas al ser entrentadas a sueros de pacientes infectados con Ascaris lumbricoides, Angiostrongylus cantdnensis y Schistosoma mansoni, lo cual demuestra que las fracciones IV y V presentan cierta especificidad para la fascioliasis y pudieran ser utilizadas en el diagnóstico de esta parasitosis a través del uso de la CIEF. Estas fracciones parecen ser componentes proteicos de bajo peso molecular que forman parte de los llamados antígenos metabólicos del parásito, ya que fueron los únicos que dieron resultados positivos al ser enfrentados a un antisuero preparado a partir de los antígenos de excreción-secreción del parásito adulto(AU)

Separación de antígenos de Fasciola hepatica por cromatografía en gel / Separation of Fasciola hapatica antigens by gel chromatography

Se procedió al fraccionamiento de un extracto soluble de adultos de Fasciola hepatica mediante una cromatografía en Sephadex G-200, obteniéndose 6 picos bien definidos y simétricos. Se obtuvieron 6 fracciones y de éstas, las 5 primeras resultaron antigénicas al ser enfrentadas al antisuero de F. hepatica mediante la técnica de contrainmunoelectroforesis (CIEF) y dieron resultados positivos frente al suero de pacientes con fascioliasis, en cambio no se observó reacción positiva alguna frente a sueros humanos normales. Todas las fracciones, a excepción de los picos IV y V, presentaron reacciones cruzadas a ser enfrentadas a sueros de pacientes infectados con Ascaris lumbricoides, Angiostrongylus cantonensis y Schistosoma mansoni, lo cual demuestra que las fracciones IV y V presentan cierta especificidad para la fascioliasis y pudieran ser utilizadas en el diagnóstico de esta parasitosis a través del uso de la CIEF. Estas fracciones parecen ser componentes proteicos de bajo peso molecular que forman parte de los llamados antígenos metabólicos del parásito, ya que fueron los únicos que dieron resultados positivos al ser enfrentados a un antisuero preparado a partir de los antígenos de excreción-secreción del parásito adulto