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1.
Article in English | MEDLINE | ID: mdl-38265699

ABSTRACT

Transgender and gender diverse (TGD) youth with chronic pain may be at unique risk for psychological distress and associated functional impairment, yet research on the intersection of chronic pain and gender identity is lacking. In a retrospective chart review of 491 participants admitted to a pediatric intensive interdisciplinary pain treatment (IIPT) program in the midwestern United States over an approximately 4-year period, 6.11% were TGD. TGD participants who completed the IIPT program reported significant and large improvements in anxiety, depression, pain catastrophizing, and functional ability. At baseline, TGD participants presented as more emotionally distressed and functionally impaired compared to age-matched, cisgender peers. When accounting for baseline scores, TGD participants who completed the IIPT program reported similar scores to cisgender peers at discharge, yet TGD youth were significantly less likely than cisgender peers to complete the IIPT program. Future directions and implications for clinical practice are discussed.

2.
Fam Med ; 56(1): 42-46, 2024 01.
Article in English | MEDLINE | ID: mdl-38055855

ABSTRACT

BACKGROUND AND OBJECTIVES: A dearth of training and resources exists for mentors to address the unique needs of faculty from racial/ethnic groups that are underrepresented in medicine (URiM). Mentoring Underrepresented Faculty for Academic Excellence (MUFAE) was a multi-institutional mentoring program designed to provide mentors where there were none. METHODS: In 2020, 25 early career URiM faculty mentees each were paired with advanced faculty, and pairs met individually for monthly calls for 1 year. Mentees completed pre- and postassessment surveys regarding their experience in the program. Mentees and mentors also participated in virtual group check-ins where they gave feedback on their experience to program leaders while also networking with fellow participants. RESULTS: Twenty-two of the 25 mentor-mentee pairs (88%) completed the program, and 17 of the 22 (77%) mentees completed the pre- and postsurveys. Survey responses showed significant increases in mentees reports of feeling they received mentorship focused on their needs as URiM faculty members, feeling equipped to advance in their careers, and feeling supported in their efforts to complete antiracism/health-equity programs. Feedback at the check-ins indicated that URiM mentors appreciated the opportunities to talk about their own frustrations and that White mentors appreciated having an increased understanding of challenges that their URIM colleagues faced. CONCLUSIONS: MUFAE is a model for academic societies to address the lack of mentors for URiM faculty. Mentees and mentors found the experience a meaningful one that fills a need in academic mentoring.


Subject(s)
Mentoring , Mentors , Humans , Program Evaluation , Faculty, Medical , Surveys and Questionnaires
4.
Respir Med Case Rep ; 44: 101876, 2023.
Article in English | MEDLINE | ID: mdl-37292171

ABSTRACT

Among patients with COPD, ventilatory inefficiency in response to exercise can be due to respiratory muscle dysfunction or expiratory flow limitation causing air-trapping and dynamic hyperinflation. We discuss a case of severe ventilatory limitation in response to exercise due to reduced respiratory muscle mass in the setting of gender-affirming hormone therapy (GAHT), and how the interpretation of pulmonary function testing (PFT) and respiratory symptoms among transgender and gender diverse (TGD) patients can be influenced by GAHT.

6.
PRiMER ; 6: 31, 2022.
Article in English | MEDLINE | ID: mdl-36119904

ABSTRACT

Introduction: More than 50% of primary care physicians' practice involves sedentary desk work. Growing evidence suggests a link between sedentary workplace behaviors and increased morbidity and mortality. Research on the effects of sit-stand desks in the workplace suggests that sit-stand desks reduce sedentary behaviors. This study examined the use and satisfaction of adjustable desks with a height of sit-stand and their association with physical self-care behaviors among family medicine residents. Methods: We conducted a longitudinal cohort survey study at a 9-9-9 family medicine residency after the clinic installed height-adjustable sit-stand desks in January 2020. Standardized questions about the use and satisfaction of adjustable sit-stand desks and physical self-care behaviors were administered in June 2020, December 2020, and December 2021. The survey also included an open text box for feedback. Results: Median time spent standing at the sit-stand desks was 55.0%. The percentage of time standing was similar across June 2020, December 2020, and December 2021. The average satisfaction rate with the desks across all time points was 71.4%. We did not observe significant differences in the proportion of residents' satisfaction with the adjustable desks over time. Residents who reported standing at the adjustable desk reported increased satisfaction with the desks (Kendall's τ=.38, P<.001) and with physical self-care behaviors (Kendall's τ=.25, P<.05). Themes associated with desk dissatisfaction revolved around limited desktop space. Conclusion: Over a nearly 1.5-year period, more than half of family medicine residents reported standing at their adjustable desks and being satisfied with them. Residents who reported standing at adjustable desks also reported increased physical self-care behaviors. Residency programs investing in sit-stand desks may consider options that allow for increased desktop surface space.

7.
J Health Serv Psychol ; 47(4): 181-189, 2021.
Article in English | MEDLINE | ID: mdl-34693297

ABSTRACT

The implementation of telepsychology soared in response to the 2019 novel coronavirus (COVID-19) pandemic. For most health service psychologists, this surge preceded formal training in telepsychology. Transgender and gender diverse (TGD) individuals reported significant vulnerabilities and health disparities during the COVID-19 pandemic. To ensure the health and well-being of adult transgender and gender diverse individuals during the COVD-19 pandemic and beyond, it is critical to promote the delivery of gender-affirming telepsychology. This article highlights clinical issues observed by health service psychologists at a high-volume gender clinic during the COVID-19 pandemic. The authors provide anticipatory guidance and recommendations to promote gender-affirming telepsychology.

8.
Prim Care ; 48(2): 243-257, 2021 Jun.
Article in English | MEDLINE | ID: mdl-33985702

ABSTRACT

Behavioral health concerns related to sexual and gender minority stress impair functioning and limit quality of life. With greater interest in implementing LGBTQ-affirmative health care practices, primary care providers likely will see larger numbers of LGBTQ individuals presenting with behavioral health concerns. Behavioral health and medical providers may not feel prepared to address the biological, psychological, social, and cultural minority stress factors that have an impact on LGBTQ patients. LGBTQ-affirmative behavioral health providers in primary care can offer a unique service by conducting tailored evaluations and individualized interventions targeting multifactorial influences that cause and perpetuate psychological distress in LGBTQ patients.


Subject(s)
Quality of Life , Sexual and Gender Minorities , Health Personnel , Health Services , Humans , Primary Health Care
9.
Biol Sex Differ ; 11(1): 55, 2020 10 06.
Article in English | MEDLINE | ID: mdl-33023634

ABSTRACT

BACKGROUND: Current understanding about health care in the gender diverse population is limited by the lack of community-based, longitudinal data, especially in the USA. We sought to characterize a community-based cohort of transgender individuals including demographics, gender identities, social characteristics, psychiatric and medical conditions, and medical therapy for gender dysphoria/incongruence. PATIENTS AND METHODS: We performed a retrospective chart review of gender diverse residents of Olmsted County, Minnesota, who sought gender-specific healthcare from January 1, 1974, through December 31, 2015, using an infrastructure that links medical records of Olmsted County residents from multiple institutions. RESULTS: The number of patients seeking gender-specific healthcare increased from 1 to 2 per 5-year interval during the 1970s-1990s to 41 from 2011 to 2015 (n = 82). Forty-nine (59.8%) were assigned male sex at birth (AMAB), 31 (37.8%) were assigned female (AFAB), and 2 (2.4%) were intersex. Gender identities evolved over time in 16.3% and 16.1% of patients AMAB and AFAB, respectively, and at most recent follow-up, 8.2% and 12.9% of patients AMAB and AFAB, respectively, were non-binary. Depression affected 78%, followed by anxiety (62.2%), personality disorder (22%), and post-traumatic stress disorder (14.6%). 58.5% experienced suicidal ideation, 22% attempted suicide, and 36.6% were victims of abuse. The most prevalent medical conditions and cardiovascular (CV) risk factors included obesity (42.7%), tobacco use (40.2%), fracture [34.1% (86.2% traumatic)], hypertension (25.6%), hyperlipidemia (25.6%), and hypertriglyceridemia (15.9%). 67.3% of patients AMAB used feminizing and 48.4% of patients AFAB used masculinizing hormone therapy. When compared to US CDC National Health Statistics, there was a significantly greater prevalence of depression and anxiety but no difference in the prevalence of obesity, hypertension, hypercholesterolemia, type 2 diabetes, or stroke. CONCLUSION: Transgender and gender diverse individuals represent a population who express various gender identities and are seeking gender-specific healthcare at increasing rates. Psychiatric illness is highly prevalent compared to the US population but there is no difference in the prevalence of CV risk factors including obesity, type 2 diabetes, hypertension, and dyslipidemia.


Subject(s)
Gender Dysphoria , Gender Identity , Transgender Persons , Adolescent , Adult , Aged , Child , Child, Preschool , Female , Humans , Male , Middle Aged , Retrospective Studies , Sex Factors , Young Adult
10.
Biotechniques ; 69(1): 384-394, 2020 07.
Article in English | MEDLINE | ID: mdl-32486835

ABSTRACT

Detecting bacteria in samples and differentiating between Gram-negative and Gram-positive species is an important challenge, and the most common method, Gram staining, is very time consuming. The aim of this study was to evaluate the electrical bioimpedance spectroscopy (EBIS) technique as an inexpensive and practical tool for real-time detection of bacteria and differentiation between Gram-positive and Gram-negative species. The relevant sensitivity for differentiating between species was found in the magnitude and phase at frequencies of 158,489 and 5248 Hz, respectively, at a bacterial concentration of 1 µg/µl. Subsequently, the sensitivity was estimated as a function of bacterial concentration. Our results demonstrated that EBIS can potentially distinguish between presence and absence of bacteria as well as between different types of bacteria.


Subject(s)
Dielectric Spectroscopy/methods , Gram-Negative Bacteria/isolation & purification , Gram-Positive Bacteria/isolation & purification , Gentian Violet/metabolism , Gram-Negative Bacteria/metabolism , Gram-Positive Bacteria/metabolism , Phenazines/metabolism , Sensitivity and Specificity , Staining and Labeling/methods
11.
Creat Nurs ; 26(2): 125-131, 2020 May 01.
Article in English | MEDLINE | ID: mdl-32321797

ABSTRACT

An estimated 1.4 million transgender adults live in the United States; this equates to approximately 0.6% of the U.S. population (Lane et al., 2018). Clinical focus on gender dysphoria has significantly increased over the past 30 years (MacCarthy, Reisner, Nunn, Perez-Brumer, & Operario, 2015), with burgeoning evidence from across disciplines documenting the positive outcomes associated with gender-affirming interventions. The purpose of this article is to illustrate how RNs optimize psychosocial, hormonal, and surgical gender-affirming care through performing comprehensive assessments, coordinating care, and providing education and health coaching.


Subject(s)
Attitude of Health Personnel , Gender Identity , Nurse's Role/psychology , Nurses/psychology , Nursing Care/psychology , Sex Reassignment Procedures/nursing , Sexual and Gender Minorities/psychology , Adult , Female , Humans , Male , Middle Aged , United States
12.
Health Serv Res ; 53(5): 3790-3808, 2018 10.
Article in English | MEDLINE | ID: mdl-29522236

ABSTRACT

OBJECTIVES: To (1) test whether patient attitudes toward intake forms at three Midwestern outpatient clinics are significantly more negative among those who are asked to complete SOGI questions versus those who are not; and (2) gain an in-depth understanding of patient concerns about SOGI questions. STUDY SETTING: Data were collected between 6/29/2015 and 2/29/2016 from new patients (N = 491) who presented at three outpatient clinics in a large academic medical center. This study was originally a quality improvement project, and later, institutional review board approval was obtained for secondary data analysis. STUDY DESIGN: Two-stage mixed-methods study. (1) Experimental: New patients at three sites were randomly assigned to complete either routine intake forms (control) or routine intake forms with SOGI questions (experimental); and (2) qualitative: interviews with patients who responded negatively to SOGI questions. PRINCIPAL FINDINGS: There were no significant differences in patient attitudes between experimental and control groups (p > .05). Of those who received SOGI questions, only 3 percent reported being distressed, upset, or offended by the SOGI questions. CONCLUSIONS: Collection of SOGI data as a part of the routine clinical patient intake process is not distressing to 97 percent of patients who are heterosexual, cisgender, and older than 50 years.


Subject(s)
Ambulatory Care Facilities , Attitude , Gender Identity , Patients/psychology , Sexual Behavior , Surveys and Questionnaires , Female , Humans , Male , Middle Aged , United States
13.
Health Serv Res Manag Epidemiol ; 4: 2333392817721648, 2017.
Article in English | MEDLINE | ID: mdl-28890910

ABSTRACT

BACKGROUND: Collaborative care management (CCM) is an evidence-based model that contributes to better outcomes for depression treatment in the primary care setting. Tobacco use increases overall economic costs, morbidity, and mortality and has been shown to impact behavioral health outcomes. Our study aims to observe clinical outcomes for depression treatment for patients with comorbid tobacco use and depression within the CCM model. METHODS: A retrospective chart review study of 2826 adult patients with depression enrolled in CCM was performed to determine the association between regular tobacco use and depression outcomes. Baseline intake data consisting of clinical and demographic variables along with 6-month follow-up of Patient Health Questionnaire-9 (PHQ-9) scores for smokers (n = 727, 25.7%) and nonsmokers (n = 2099, 74.3%) were obtained. Depression remission was defined as a PHQ-9 score <5 and persistent depressive symptoms (PDS) as a PHQ-9 score ≥10 at 6 months. RESULTS: Using an intention-to-treat analysis, the multivariate modeling demonstrated that smokers, at 6 months, had an increased adjusted odds ratio (AOR) for PDS: 1.624 (95% CI: 1.353-1.949). Furthermore, smokers had a lower AOR of depression remission: 0.603 (95% CI: 0.492-0.739). Patient adherence to treatment was also lower in smokers with an AOR of 0.666 (95% CI: 0.553-0.802). CONCLUSIONS: Smokers enrolled in CCM were associated with reduced treatment adherence and worse outcomes for depression treatment at 6 months compared to nonsmokers, even when baseline clinical and demographic variables were controlled. Thus, new tailored practices may be warranted within the CCM model to treat comorbid depression and tobacco use disorders.

14.
J Prim Care Community Health ; 8(4): 233-238, 2017 Oct.
Article in English | MEDLINE | ID: mdl-28613090

ABSTRACT

BACKGROUND: Individuals with personality disorders (PDs) are high utilizers of primary care and mental health services; however, they struggle to utilize the care effectively and studies have shown a strong association between having a PD and higher impairment in social role functioning. This is especially important because PDs are highly comorbid with a wide range of other mental health disorders. The collaborative care model (CCM) for depression was developed with an emphasis on patient engagement and aimed to reduce health care utilization, while improving treatment outcomes in primary care. We hypothesized that the diagnosis of a personality disorder in primary care patients will negatively affect 6-month depression outcomes after enrollment into a CCM. METHODS: This retrospective chart review study was conducted on patients enrolled into CCM over a period of 7 years with collection of 6-month follow-up data. A total of 2826 patients were enrolled into CCM with a clinical diagnosis of depression and a baseline Patient Health Questionnaire-9 (PHQ-9) ≥10 were included in the study cohort. Using the depression database, baseline and 6-month follow-up data were obtained. Adjusted odds ratios (AORs) were determined for both remission and persistent depressive symptoms using logistic regression modeling for the 6-month PHQ-9 outcome; while retaining all the study variables. RESULTS: Of the 2826 CCM patients with depression in our study, 216 (7.6%) were found to have a PD. Patients with PD were younger (37.7 vs 42.5 years, P < .001) and more likely to be unmarried (36.1% vs 55.6%, P < .001) than patients without a PD. While age, marital status, clinical diagnosis, and Mood Disorders Questionnaire (MDQ) score were significant predictors of remission; anxiety symptoms, gender, and race were not. The presence of a PD diagnosis was associated with a 60% lower likelihood of remission at 6 months (AOR = 0.39; 95% CI 0.28-0.54). Conversely, patients without a PD were 2.5 times as likely to experience remission at 6-month remission compared to patients with PD (AOR =2.57; 95% CI 1.85-3.56). CONCLUSION: Patients with a personality disorder were more likely to have a recurrent depressive disorder diagnosis, an abnormal MDQ score, increased anxiety symptoms, and higher baseline PHQ-9 score. Patients with PD had worse CCM outcomes at 6 months with only 25.0% able to achieve remission versus 54.3% ( P < .001) without a PD. The presence of a PD with depression was associated with poor outcomes (reduced remission rates and increased persistent depressive symptoms rates) in comparison to patients without a diagnosis of PD, while treated within CCM.


Subject(s)
Depressive Disorder/therapy , Personality Disorders/psychology , Adolescent , Adult , Aged , Aged, 80 and over , Anxiety/psychology , Borderline Personality Disorder/epidemiology , Borderline Personality Disorder/psychology , Comorbidity , Compulsive Personality Disorder/epidemiology , Compulsive Personality Disorder/psychology , Cooperative Behavior , Dependent Personality Disorder/epidemiology , Dependent Personality Disorder/psychology , Depressive Disorder/epidemiology , Depressive Disorder/psychology , Female , Humans , Logistic Models , Male , Middle Aged , Odds Ratio , Patient Health Questionnaire , Personality Disorders/epidemiology , Primary Health Care , Recurrence , Remission Induction , Retrospective Studies , Treatment Outcome , Young Adult
15.
J Am Board Fam Med ; 30(3): 281-287, 2017.
Article in English | MEDLINE | ID: mdl-28484060

ABSTRACT

BACKGROUND: The goal of this study was to develop and validate an assessment tool for adult primary care patients diagnosed with depression to determine predictive probability of clinical outcomes at 6 months. METHODS: We retrospectively reviewed 3096 adult patients enrolled in collaborative care management (CCM) for depression. Patients enrolled on or before December 31, 2013, served as the training set (n = 2525), whereas those enrolled after that date served as the preliminary validation set (n = 571). RESULTS: Six variables (2 demographic and 4 clinical) were statistically significant in determining clinical outcomes. Using the validation data set, the remission classifier produced the receiver operating characteristics (ROC) curve with a c-statistic or area under the curve (AUC) of 0.62 with predicted probabilities than ranged from 14.5% to 79.1%, with a median of 50.6%. The persistent depressive symptoms (PDS) classifier produced an ROC curve with a c-statistic or AUC of 0.67 and predicted probabilities that ranged from 5.5% to 73.1%, with a median of 23.5%. CONCLUSIONS: We were able to identify readily available variables and then validated these in the prediction of depression remission and PDS at 6 months. The DOC-6 tool may be used to predict which patients may be at risk for worse outcomes.


Subject(s)
Clinical Decision-Making , Decision Support Techniques , Depression/diagnosis , Health Status Indicators , Primary Health Care , Adolescent , Adult , Aged , Aged, 80 and over , Depression/therapy , Female , Follow-Up Studies , Humans , Male , Middle Aged , Prognosis , ROC Curve , Retrospective Studies , Young Adult
16.
J Prim Prev ; 38(4): 419-445, 2017 Aug.
Article in English | MEDLINE | ID: mdl-28405831

ABSTRACT

The current study examined demographics, sexual orientation, gender characteristics, and gender minority stress and their association to excessive alcohol, cannabis, and illicit (noncannabis) drug use among 1210 transgender adults living in the United States. The authors conducted a secondary analysis of data that included 680 transgender women (M age = 32.63, SD age = 12.29) and 530 transgender men (M age = 26.14, SD age = 7.42). A modified version of the Risk Behavioral Assessment quantified participants' alcohol, cannabis, and illicit drug use in the past 3 months. Overall, 21.5% of participants reported excessive alcohol use; no significant differences were found on the rates of excessive alcohol use between transgender women and men. Cannabis use among our sample was 24.4%; trangender men reported significantly higher rates of cannabis use compared to transgender women. Illicit drug (noncannabis) use among our sample was 11.6%; transgender men also reported significantly higher rates of illicit drug use compared to transgender women. Multivariate analyses suggested that gender dysphoria was significantly associated with: excessive alcohol use for transgender women, cannabis use among both transgender women and men, and illicit (noncannabis) drug use among transgender women. A nonheterosexual orientation was associated with increased odds of cannabis use among transgender women and men; a nonheterosexual orientation was associated with greater odds of illicit substance use among transgender men but not among transgender women. Gender minority stressors were independently associated with excessive alcohol use among transgender men and cannabis use among transgender women. The authors suggest that minority stress may only partially account for substance use among transgender people. Consequently, the authors suggest that in addition to minority stress, other biopsychosocial mechanisms should continue to be examined to identify pathways that may lead to the development of effective substance use prevention efforts and treatment programs.


Subject(s)
Illicit Drugs , Minority Groups/psychology , Sexuality/psychology , Stress, Psychological/epidemiology , Substance-Related Disorders/epidemiology , Transgender Persons/psychology , Adult , Family Characteristics , Female , Humans , Male , Sex Factors , United States , Young Adult
17.
PRiMER ; 1: 5, 2017 Sep.
Article in English | MEDLINE | ID: mdl-32944691

ABSTRACT

BACKGROUND: Lack of wellness among physicians has been associated with increased risk for physical and mental illness, interpersonal discord, and occupational liability. In academic primary care practices, physician wellness and self-care behaviors have been associated with improved patient outcomes. With the increase in team-based care structures in primary care clinics and residencies there may be opportunities to promote wellness among primary clinicians, particularly among resident physicians who are at increased risk for decreased well being. The primary objective of the study was to test an a priori hypothesis that family medicine residents' perception of support from preceptor team leads would be associated with well being. A secondary objective of the study was to test a post hoc hypothesis that examined whether the relationship between residents' perception of support from their preceptor team leads would be associated with residents' well being, while controlling for self-care behaviors. METHODS: Our study utilized a prospective cross-sectional design with purposive sampling to survey family medicine residents. Data were collected in February 2016. The survey was sent out to 58 family medicine residents across three family medicine residencies at Mayo Clinic. The survey response rate was 55% (n=32); Ten (31.3%) residents reported being in their PGY-1, 11 (34.4%) in PGY-2; and 11 (34.4%) in PGY-3; participants included 19 (59.4%) women and 13 (40.6%) men. The Brief Resident Wellness Profile (BRWP) was utilized to assess family medicine residents' perceived sense of professional accomplishment and mood in the past week. RESULTS: In bivariate correlational analyses, increased perception of support from preceptor team leads (r=.40, P<.01) and reporting a male gender (r=.43, P<.01) was associated with increased resident wellness. In exploratory multivariate analysis, results suggested that while controlling for gender, frequency of self-care behaviors, and perceived preceptor team lead support, a one-point change on rating of perceived team leader support is associated with a 1.69 increase in resident wellness score on the BRWP. CONCLUSIONS: Our results provide preliminary evidence to support the relationship between preceptor team lead support and resident wellness in team-based care, above and beyond the impact that self-behaviors have on wellness. Our findings suggest evidence for the subsequent study of the impact of preceptor team lead relationship quality on resident wellness.

18.
Rev. colomb. cardiol ; 23(5): 351-360, sep.-oct. 2016. tab, graf
Article in Spanish | LILACS, COLNAL | ID: biblio-959894

ABSTRACT

Resumen Objetivo: Evaluar el uso concomitante de la warfarina y el acetaminofén en una población ambulatoria de pacientes anticoagulados, como posible factor de riesgo en el aumento de la Relación Normalizada Internacional (INR). Métodos: Estudio de cohortes retrospectivo. Se analizó la información de 1.458 pacientes anticoagulados con la warfarina. El factor de riesgo fue la utilización conjunta de warfarina- acetaminofén; el tiempo de seguimiento fue de 1 mes y como evento final se consideró un incremento del INR igual o mayor a 0,5 unidades. La asociación del factor de riesgo con el evento final se estableció con el riesgo relativo (RR) y el riesgo atribuible poblacional (RAP). Resultados: 63 pacientes cumplieron criterios de inclusión, 21 pacientes expuestos y 42 pacientes no expuestos. En los individuos expuestos se observó un aumento estadísticamente significativo en el INR al mes siguiente de haber iniciado el tratamiento con el acetaminofén comparado con el momento de ingreso al estudio (mes 1: mediana 3,06 vs. mes 0: mediana 2,63), (valor p = 0,003). En contraste, en los sujetos no expuestos no se observaron diferencias estadísticamente significativas en los valores del INR (mes 0: mediana 2,63 vs. mes 1: mediana 2,75), (valor p = 0,115). El uso de la warfarina y el acetaminofén representó un RR de 2,5 veces mayor de incrementar el INR mayor o igual de 0,5 unidades. Conclusión: El uso concomitante de la warfarina y el acetaminofén está asociado a un aumento del INR igual o mayor de 0,5 unidades, lo cual podría generar un mayor efecto anticoagulante y, por tanto, un mayor riesgo potencial de sangrado.


Abstract Motivation: To assess concomitant use of warfarin and acetaminophen in an outpatient population of patients receiving blood-thinning drugs as a possible risk factor for the increase of International Normalised Ratio (INR). Methods: Retrospective cohort study. The information pertaining 1,458 patients receiving blood-thinning drugs with warfarin was analysed. The risk factor was the joint intake of warfarin and acetaminophen; follow-up time was 1 month and the final event considered was a INR increase of or higher than 0.5 units. The association of the risk factor with the final event was establish with the Relative Risk (RR) and the Population Attributable Risk (PAR). Results: 63 patients met the inclusion criteria, of whom 21 were exposed patients and 42 were unexposed patients. In the exposed patients a statistically significant increase of INR on the month following the onset of treatment with acetaminophen was observed, compared to the baseline values (month 1: median 3.06 vs. month 0: median 2.63), (p = 0.003). In contrast, no statistically significant differences of INR values were observed in unexposed individuals (month 0: median 2.63 vs. month 1: median 2.75) (p = 0.115). The combination of warfarin and acetaminophen represented a RR 2.5 times higher to increase INR greater than or equal to 0.5 units. Conclusion: Concomitant use of warfarin and acetaminophen is associated to an increase of INR equal to or greater than 0.5 units, which could generate a higher blood-thinning effect and, thus, cause a potentially higher risk of bleeding.


Subject(s)
Humans , Male , Aged , Warfarin , Acetaminophen , Anticoagulants/administration & dosage , Pharmaceutical Preparations , Risk Factors , Hemorrhage
19.
J Prim Care Community Health ; 7(3): 159-64, 2016 07.
Article in English | MEDLINE | ID: mdl-26994060

ABSTRACT

Posttraumatic stress disorder (PTSD) has symptoms that exist along a spectrum that includes depression and the 2 disorders may coexist. Collaborative care management (CCM) has been successfully used in outpatient mental health management (especially depression and anxiety) with favorable outcomes. Despite this, there exist limited data on clinical impact of a diagnosis of PTSD on depression outcomes in CCM. The present study used a retrospective cohort design to examine the association of PTSD with depression outcomes among 2121 adult patients involved in CCM in a primary care setting. Using standardized self-report measures, baseline depression scores and 6-month outcome scores were evaluated. Seventy-six patients had a diagnosis of PTSD documented in their electronic medical record. Patients with PTSD reported more severe depressive symptoms at baseline (Patient Health Questionnaire-9 score of 17.9 vs 15.4, P < .001) than those without PTSD. Controlling for sociodemographic and clinical characteristics, a clinical diagnosis of PTSD was associated with lower odds (AOR = 0.457, CI = 0.274-0.760, P = .003) of remission at 6 months and was also associated with higher odds (AOR = 3.112, CI = 1.921-5.041, P < .001) of persistent depressive symptoms at 6 months after CCM. When coexisting with depression, a diagnosis of PTSD was associated with worse depression outcomes, when managed with CCM in primary care. Opportunities still exist for more aggressive management of depression in these patients to help improve remission as well as reduce persistent depressive symptoms.


Subject(s)
Delivery of Health Care/methods , Depression/therapy , Depressive Disorder/therapy , Mental Health Services/organization & administration , Patient Care Team , Stress Disorders, Post-Traumatic/complications , Adolescent , Adult , Aged , Aged, 80 and over , Cooperative Behavior , Depression/etiology , Depressive Disorder/etiology , Female , Humans , Male , Middle Aged , Odds Ratio , Primary Health Care , Self Report , Treatment Outcome , Young Adult
20.
J Nanosci Nanotechnol ; 15(12): 9591-6, 2015 Dec.
Article in English | MEDLINE | ID: mdl-26682383

ABSTRACT

The use of magnetic nanoparticles have been proposed as alternative techniques to assist breast cancer diagnosis and treatment. Peritumoral and intratumoral biodistribution of magnetic nanoparticles have been the main practical approaches, and the evaluation of breast tumor tissue marked selectively by magnetic nanoparticles has been not widely studied so far. The aim of this study was to evaluate the c-erbB-2 antigen in tissue of a breast cancer animal model as specific target for the use of magnetic nanoparticles coupled to specific Monoclonal Antibody (Mab). A breast cancer animal model was adapted and standardized in female rats. Tumor tissue was characterized histopathological and inmunohistochemical for cancer type and c-erbB-2 expression respectively. A bioconjugate was developed by the covalent union of fluorescent magnetic nanoparticles and anti c-erbB-2 Mab, and was used for incubation in two consecutive slides of breast cancer tissue acoordingly following conditions: (a) the c-erbB-2 receptor previously blocked by a primary antibody, and (b) the c-erbB-2 receptor non-blocked. Microscopy fluorescence was used to determine the selective marked of tumor tissue by the bioconjugate. Healthy breast tissue was used as negative control of selective labeling of the bioconjugate. The results show a well-differentiated fluorescent mark by magnetic nanoparticles in the non-blocked c-erbB-2 receptor breast cancer tissue condition, the observation suggests the use of the c-erbB-2 antigen as specific target to mark selectively breast tumor tissue by magnetic nanoparticles.


Subject(s)
Antibodies, Monoclonal/chemistry , Breast Neoplasms/diagnostic imaging , Magnetite Nanoparticles/chemistry , Receptor, ErbB-2/chemistry , Animals , Female , Humans , Neoplasms, Experimental/diagnostic imaging , Rats , Tissue Distribution
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