Associations between the social environment and early childhood developmental outcomes of Puerto Rican children with prenatal Zika virus exposure: a cross-sectional study.

BACKGROUND: Prenatal exposure to the Zika virus can lead to microcephaly and adverse developmental outcomes, even in children without evident birth defects. The social environment plays a crucial role in infant health and developmental trajectories, especially during periods of heightened brain plasticity. The study aimed to assess socioenvironmental factors as predictors of developmental outcomes of 36-month-old children exposed to Zika virus prenatally. STUDY DESIGN: This cross-sectional study included 53 mothers and 55 children enrolled in the Pediatric Outcomes of Prenatal Zika Exposure cohort study in Puerto Rico. The study performs follow-up developmental assessments of children born to mothers with confirmed and probable Zika virus infection during pregnancy. Mothers completed socioenvironmental questionnaires (e.g., Perceived Neighborhood Scale and US Household Food Insecurity Survey). Children's developmental outcomes were assessed with the Bayley Scales of Infant and Toddler Development: Third Edition, the Ages and Stages Questionnaires: Third Edition, the Ages and Stages Questionnaire-Socioemotional: Second Edition, and the Child Adjustment and Parent Efficacy Scale. RESULTS: Linear regression models, adjusting for a child's sex and age and maternal education, revealed that early life exposure to food insecurity and maternal pregnancy stressors were significantly associated with poorer developmental outcomes in Zika virus-exposed children at 36 months of age. Maternal resilience representation of adaptive ability was associated with the preservation of adequate developmental outcomes in children. CONCLUSIONS: Pregnancy and early childhood are critical life periods for ensuring optimal brain development in children. While the mechanisms in the interaction of children with their environment are complex, the risk and protective factors identified in the study are modifiable through public policy and preventive initiatives. Implementation of comprehensive strategies that improve access to social support programs, educational and nutritional interventions, and mental health services during pregnancy and early childhood can enhance the developmental potential of vulnerable children.

Healthcare and Social Needs Assessment and Response Quality Among Black Men.

To understand Black men's healthcare and social needs and determine if the resources that healthcare systems offer meet expectations. We surveyed men who had previously participated in at least one Minority Men's Health Fair in Cleveland, Ohio. In this descriptive study, we spoke with men up to three times (i.e., phases) between May and October 2020 by email and/or telephone. Phase 1 was a needs assessment survey. Phase 2 involved outreach to those who identified a need to provide a resource. Phase 3 determined whether the resource met individuals' needs. We described the demographic characteristics of the survey respondents, the percentage of men reporting a need and wanting a resource, and whether the resource resolved their need. Of the 768 men contacted, 275 completed the survey (36% response rate). The majority of respondents were 50-69 years old, identified as Black, and had at least a bachelor's degree. Eighty-five percent reported a need, of which wellness, financial, and healthcare access were among the top-reported needs. Among the men identifying a need, 35% were interested in a resource. Resources that were provided for employment, behavioral health, oral health, vision, or wellness needs were deemed insufficient. A few individuals reported that resources for food/personal hygiene, financial support, health care access, annual health screening, and medication met their needs. Among men with healthcare and social needs, only a fraction were interested in a resource, and fewer reported that the resource met their needs. These results warrant a greater understanding of what constitutes a resolution of healthcare and social needs from patients' perspectives.

Stressors and Impact of the COVID-19 Pandemic on Vulnerable Hispanic Caregivers and Children.

Psychological sequelae are important elements of the burden of disease among caregivers. Recognition of the impact of adversity and stress biomarkers is important to prevent mental health problems that affect rearing practices and child well-being. This cross-sectional study explored social determinants of health (SDoH)-mediated stressors during COVID-19 and risks for mental health problems among caregivers of children with prenatal Zika virus exposure. Twenty-five Hispanic caregivers completed surveys assessing SDoH vulnerabilities, COVID-exposures and impact, post-traumatic stress disorder (PTSD) symptomatology, and provided a hair sample for cortisol concentration (HCC). Most caregivers had low education, household income < $15,000/year, and were unemployed. Stressors included disrupted child education and specialized services, and food insecurity. While most reported PTSD symptomatology, multivariate linear regression models adjusted for the caregiver's age, education, and the child's sex, revealed that caregivers with high symptomatology had significantly lower HCC than those with low symptomatology and those with food insecurity had significantly higher HCC than participants without food insecurity. The impact of COVID-19 on daily life was characterized on average between worse and better, suggesting variability in susceptibility and coping mechanisms, with the most resilient identifying community support and spirituality resources. SDoH-mediators provide opportunities to prevent adverse mental health outcomes for caregivers and their children.

Early Childhood Neurodevelopmental Outcomes in Children with Prenatal Zika Virus Exposure: A Cohort Study in Puerto Rico.

OBJECTIVE: To describe anthropometric, sensory, and neurodevelopmental outcomes of children who were Zika virus-exposed from birth to 36 months. STUDY DESIGN: The study cohort included 114 children born to mothers with confirmed and probable Zika virus pregnancy infection in 2016-2017. Children attending study visits from May 2017 through February 2020 underwent physical/neurologic, sensory examinations, and neurodevelopmental assessments with the Bayley Scales of Infant and Toddler Development, Third Edition (BSID-III) and Ages and Stages Questionnaires, Third Edition (ASQ-3). RESULTS: Three of the 114 children (2.6%) had microcephaly (z-score for head circumference ≤-2) at birth, 19 of 35 (54.3%) had posterior eye abnormalities in retinal images, and 11 of 109 (10.1%) had nonspecific findings on brain ultrasound. Three of 107 children (2.8%) failed hearing screening at birth. Of those children with follow-up data, 17 of 97 (17.5%) failed age-appropriate vision screening. The BSID-III identified developmental delay in at least 1 domain in at least one-third of children, with higher prevalence in the language domain. ASQ-3 screen positive delay peaked at around 24 or 36 months, with some domains showing a decrease at older ages. Correlations among BSID-III and ASQ-3 scores were observed, representing professional and parental perspectives at 24 and 36 months (r = 0.32-0.78; P < .05). CONCLUSIONS: The presence of neurodevelopmental sequelae in early childhood suggests that identification of long-term impairment remains critical to attaining optimal child development. Long-term follow-up highlights vulnerability in the language domain, which likely could be influenced by early intervention, promoting cognitive development and school readiness in exposed children.

A nutrition and lifestyle-focused shared medical appointment in a resource-challenged community setting: a mixed-methods study.

BACKGROUND: In order to address disparities in preventable chronic diseases, we adapted a nutrition and lifestyle-focused shared medical appointment (SMA) program to be delivered in an underserved community setting. The objective was to evaluate a community-based nutrition and lifestyle-focused SMA as it relates to acceptability and health and behavior-related outcomes. METHODS: A mixed-methods study was performed to evaluate pre-post changes in wellness indices, biometrics, self-efficacy, and trust in medical researchers as part of a community-based SMA. To understand program acceptability including barriers and facilitators for implementation and scalability, we conducted two participant focus groups and five stakeholder interviews and used content analysis to determine major themes. RESULTS: Fifteen participants attended 10 weekly sessions. The majority were older adult, African American women. There were pre-post improvements in mean [SD] systolic (-10.5 [7.7] mmHg, p = 0.0001) and diastolic (-4.7 [6.7] mmHg, p = 0.17) blood pressures and weight (-5.7 [6.3] pounds, p = 0.003) at 3 months though these were not significant at 6 months. More individuals reported improvements in health status, daily fruit and vegetable intake, and sleep than at baseline. There were no significant pre-post changes in other wellness indices, self-efficacy, trust in medical researchers, hemoglobin A1c, insulin, or LDL cholesterol. Participants discussed positive health changes as a result of the SMA program, program preferences, and facilitators and barriers to continuing program recommendations in focus groups. SMA implementation was facilitated by clinical staff who adjusted content to a low health literacy group and partnership with a trusted community partner. Sustainability barriers include heavy personnel time and in-kind resources to deliver the program. CONCLUSIONS: Nutrition and lifestyle-focused SMAs in a resource-challenged community setting may be an acceptable intervention for underserved patients.

Patient outcomes and costs associated with functional medicine-based care in a shared versus individual setting for patients with chronic conditions: a retrospective cohort study.

OBJECTIVE: To compare outcomes and costs associated with functional medicine-based care delivered in a shared medical appointment (SMA) to those delivered through individual appointments. DESIGN: A retrospective cohort study was performed to assess outcomes and cost to deliver care to patients in SMAs and compared with Propensity Score (PS)-matched patients in individual appointments. SETTING: A single-centre study performed at Cleveland Clinic Center for Functional Medicine. PARTICIPANTS: A total of 9778 patients were assessed for eligibility and 7323 excluded. The sample included 2455 patients (226 SMAs and 2229 individual appointments) aged ≥18 years who participated in in-person SMAs or individual appointments between 1 March 2017 and 31 December 2019. Patients had a baseline Patient-Reported Outcome Measurement Information System (PROMIS) Global Physical Health (GPH) score and follow-up score at 3 months. Patients were PS-matched 1:1 with 213 per group based on age, sex, race, marital status, income, weight, body mass index, blood pressure (BP), PROMIS score and functional medicine diagnostic category. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome was change in PROMIS GPH at 3 months. Secondary outcomes included change in PROMIS Global Mental Health (GMH), biometrics, and cost. RESULTS: Among 213 PS-matched pairs, patients in SMAs exhibited greater improvements at 3 months in PROMIS GPH T-scores (mean difference 1.18 (95% CI 0.14 to 2.22), p=0.03) and PROMIS GMH T-scores (mean difference 1.78 (95% CI 0.66 to 2.89), p=0.002) than patients in individual appointments. SMA patients also experienced greater weight loss (kg) than patients in individual appointments (mean difference -1.4 (95% CI -2.15 to -0.64), p<0.001). Both groups experienced a 5.5 mm Hg improvement in systolic BP. SMAs were also less costly to deliver than individual appointments. CONCLUSION: SMAs deliver functional medicine-based care that improves outcomes more than care delivered in individual appointments and is less costly to deliver.

Addressing COVID-19 health disparities through a regional community health response.

To combat racial/ethnic and socioeconomic health disparities associated with COVID-19 in our surrounding communities, the Cleveland Clinic Community Health & Partnership team developed a comprehensive program focused on connecting and communicating with local officials, faith-based organizations, and individual community members. Since March of 2020, our team has donated resources (e.g., personal protective equipment) to local organizations, referred thousands of community members to community or clinical resources, and partnered with federally-qualified health centers to support community COVID-19 testing. Future work will include the use of these networks to deploy the COVID-19 vaccine.

Factores que influyen en el destete precoz de lactantes pertenecientes al Centro de Salud Augusto Egas, Ecuador / Fatores que influenciam o desmame precoce em bebês pertencentes ao Centro de Saúde Augusto Egas, Equador / Factors that influence the early weaning on infants belonging to the Augusto Egas Health Center, Ecuador

Introducción: La lactancia materna exclusiva aporta macro y micronutrientes que son suficientes para un correcto desarrollo y crecimiento del lactante. La promoción de la lactancia materna exclusiva debe ser óptima, puesto que en la actualidad el destete precoz ha aumentado en gran magnitud. Objetivo: Determinar qué factores influyen en el destete precoz en madres con lactantes de 0 a 11 meses en el Centro de Salud Augusto Egas, de la ciudad de Santo Domingo, Ecuador. Método: Se utilizó un estudio correlacional, descriptivo, con enfoque cuantitativo, durante el periodo de julio hasta inicios de agosto de 2021, en una población de 252 madres que asistieron dicha unidad de salud. Se realizó un muestreo por conveniencia donde se obtuvo una muestra de 153 madres. Las variables medidas, fueron: dificultades a inicio de la lactancia materna, alimentos con los que complementaron la lactancia materna exclusiva, abandono precoz, mitos que influyeron en el abandono parcial o completo de la lactancia materna exclusiva y madres que recibieron información después del parto. Resultados: El 85 por ciento de las madres refirió dificultades en la cantidad suficiente de leche. Las madres no abandonaron la lactancia por decisión propia, el 64,7 por ciento expresó no creer en los mitos. Hubo mayoría de acuerdo en haber recibido una correcta información después del parto por parte del personal de salud (64,7 por ciento). Conclusión: La insuficiente cantidad de leche en las madres es el factor que más influye en esta unidad de salud, por lo que optan por una alimentación mixta(AU).

Introduction: Exclusive breastfeeding provides macro and micronutrients that are sufficient for the correct development and growth of the infant. The promotion of exclusive breastfeeding should be optimal, since early weaning has greatly increased nowadays. Objective: To determine what factors influence early weaning in mothers with infants from 0 to 11 months at the Augusto Egas Health Center, in the city of Santo Domingo, Ecuador. Method: A descriptive correlational study was undertaken, with a quantitative approach, during the period from July to the beginning of August 2021, in a population of 252 mothers who attended this health unit. A convenience sampling was carried out, and a sample of 153 mothers was obtained. The variables measured were: difficulties at the beginning of breastfeeding, foods that supplemented exclusive breastfeeding, early abandonment, myths that influenced the partial or complete abandonment of exclusive breastfeeding, and mothers who received information after delivery. Results: 85 percent of the mothers reported difficulties in the sufficient quantity of milk. Mothers did not abandon breastfeeding by their own decision, 64.7 percent expressed not believing in the myths. There was a majority of agreement in having received correct information after delivery from health personnel (64.7 percent). Conclusion: The insufficient amount of milk in mothers is the factor that influences the most in this health unit, so they opted for a mixed diet(AU).

Introdução: O aleitamento materno exclusivo fornece macro e micronutrientes suficientes para o correto desenvolvimento e crescimento da criança. A promoção do aleitamento materno exclusivo deve ser ótima, pois hoje o desmame precoce aumentou muito. Objetivo: determinar quais fatores influenciam o desmame precoce de mães com bebês de 0 a 11 meses no Centro de Saúde Augusto Egas, na cidade de Santo Domingo, Equador. Método: Foi utilizado um estudo descritivo correlacional, com abordagem quantitativa, no período de julho a início de agosto de 2021, em uma população de 252 mães atendidas nesta unidade de saúde. Realizou-se uma amostragem por conveniência, obtendo-se uma amostra de 153 mães. As variáveis mensuradas foram: dificuldades no início da amamentação, alimentos que complementavam a amamentação exclusiva, abandono precoce, mitos que influenciaram no abandono parcial ou total do aleitamento materno exclusivo e mães que receberam informações após o parto. Resultados: 85 porcento das mães relataram dificuldade na quantidade suficiente de leite. As mães não abandonaram a amamentação por decisão própria, 64,7 porcento expressaram não acreditar nos mitos. Houve maior concordância em ter recebido informações corretas do pessoal de saúde após o parto (64,7 porcento). Conclusão: A quantidade insuficiente de leite das mães é o fator que mais influencia esta unidade de saúde, por isso optam por uma alimentação mista(AU).

Respiratory syncytial virus seropositivity at birth is associated with adverse neonatal respiratory outcomes.

BACKGROUND: More than 60 years since the discovery of the respiratory syncytial virus (RSV), the effects of prenatal exposure to this virus remain largely unknown. In this investigation, we sought to find evidence of RSV seroconversion in cord blood and explore its clinical implications for the newborn. METHODS: Offspring from 22 pregnant women with a history of viral respiratory infection during the third trimester of pregnancy (respiratory viral illness [RVI] group) and 40 controls were enrolled in this study between 1 September 2016 and 31 March 2019. Cord blood sera were tested for anti-RSV antibodies by indirect fluorescent antibody assay. RSV seropositivity was defined as the presence of anti-RSV immunoglobulin M (IgM) or immunoglobulin A (IgA), in addition to IgG in cord blood serum at ≥1:20 dilution. RESULTS: Anti-RSV IgG was present in all cord blood serum samples from infants born to RVI mothers (95% confidence interval [CI] = 82%-100%), with 16 samples also having elevated titers for either anti-RSV IgA or IgM (73%; 95% CI = 52%-87%). No controls had evidence of anti-RSV antibodies. Eight (50%) seropositive newborns developed at least one respiratory tract finding, including respiratory distress syndrome (N = 8), respiratory failure (N = 3), and pneumonia (N = 1). RSV seropositive newborns also required more days on oxygen, had leukocytosis and elevated C-reactive protein (P = .025, P = .047, and P < .001, respectively). CONCLUSION: This study provides evidence of acute seropositivity against RSV in cord blood of newborns delivered from mothers with a history of upper respiratory tract illness in the third trimester. Cord blood seropositivity for anti-RSV IgA or IgM was associated with adverse clinical and laboratory outcomes in newborns.

Association of the Functional Medicine Model of Care With Patient-Reported Health-Related Quality-of-Life Outcomes.

Importance: The incidence of chronic disease is increasing along with health care-related costs. The functional medicine model of care provides a unique operating system to reverse illness, promote health, and optimize function. The association between this model of care and patient's health-related quality of life (HRQoL) is unknown. Objective: To assess the association between functional medicine and patient-reported HRQoL using Patient-Reported Outcome Measurement Information System (PROMIS) global health measures. Design, Setting, and Participants: A retrospective cohort study was performed to compare 7252 patients aged 18 years or older treated in a functional medicine setting with propensity score (PS)-matched patients in a primary care setting. Sensitivity analyses assessed improvement limited to patients seen at both 6 and 12 months. The study included patients who visited the Cleveland Clinic Center for Functional Medicine or a Cleveland Clinic family health center between April 1, 2015, and March 1, 2017. Main Outcomes and Measures: The primary outcome was change in PROMIS Global Physical Health (GPH) at 6 months. Secondary outcomes included PROMIS Global Mental Health (GMH) at 6 months and PROMIS GPH and GMH at 12 months. The PROMIS GPH and GMH scores were transformed to a T-score from 0 to 100 with a mean of 50. Higher scores indicate a better health-related quality of life. Results: Of the 7252 patients (functional medicine center: 1595; family health center: 5657), 4780 (65.9%) were women; mean (SD) age was 54.1 (16.0) years. At 6 months, functional medicine patients exhibited significantly larger improvements in PROMIS GPH T-score points than were seen in patients treated at a family health center (mean [SD] change, functional medicine center: 1.59 [6.29] vs family health center: 0.33 [6.09], P = .004 in 398 PS-matched pairs). At 12 months, functional medicine patients showed improvement similar to that observed at 6 months; however, comparisons with patients seen at the family health center were not significant. Patients in the functional medicine center with data at both 6 and 12 months demonstrated improvements in PROMIS GPH (mean [SD], 2.61 [6.53]) that were significantly larger compared with patients seen at a family health center (mean [SD], 0.25 [6.54]) (P = .02 in 91 PS-matched pairs). Conclusions and Relevance: In this study, the functional medicine model of care demonstrated beneficial and sustainable associations with patient-reported HRQoL. Prospective studies are warranted to confirm these findings.

APPLICATION OF 3-HYDROXYBUTYRATE MEASUREMENT AND PLASMA PROTEIN ELECTROPHORESIS IN THE DIAGNOSIS OF ASPERGILLOSIS IN AFRICAN PENGUINS ( SPHENISCUS DEMERSUS).

New alternative laboratory means are needed to improve the options for antemortem diagnosis of avian aspergillosis. In this study, 3-hydroxybutyrate was measured in plasma samples collected from a cohort of African penguins ( Spheniscus demersus) maintained under human care. Results were interpreted in combination with those of protein electrophoresis and compared with anti- Aspergillus antibody and galactomannan antigen detection. Overall, 3-hydroxybutyrate levels were found significantly increased in Aspergillus-diseased cases versus the control penguin group ( P = 0.002). Mean absolute concentration of ß-globulins was increased >20% in samples from infected birds, and α2-globublins were also found to be significantly increased versus clinically normal controls ( P < 0.001 and P = 0.001 respectively). Of note, the α2-globulins were also significantly increased versus penguins with inflammatory (non-aspergillosis) diseases ( P = 0.001). The specificity of 3-hydroxybutyrate, ß-globulins, and α2-globulins for aspergillosis was 78.6%, 79.6%, and 92.2%, respectively. Using these measures in tandem resulted in high specificity (>90%) and negative predictive value (≥80%). In contrast, anti- Aspergillus antibody and galactomannan antigen did not distinguish between infected cases and controls ( P > 0.05). This study demonstrates that basic testing in tandem with the new biomarker 3-hydroxybutyrate may provide reliable evidence for the diagnosis of aspergillosis in penguins.

Circulating angiogenic factors are related to the severity of gestational hypertension and preeclampsia, and their adverse outcomes.

Gestational hypertension (GH) and preeclampsia (PE) are characterized by an imbalance in angiogenic factors. However, the relationship among these factors with the severity of hypertensive disorders of pregnancy (HDP) and adverse outcomes are not fully elucidated. We examined whether these biomarkers are related with the severity of HDP and adverse outcomes.Using a cross-sectional design, serum concentrations of placental growth factor (PlGF), soluble fms-like tyrosine kinase-1 (sFlt-1), and soluble endoglin were determined in 764 pregnant women: 75 healthy pregnant, 83 with mild GH (mGH), 105 with severe GH (sGH), 122 with mild PE (mPE), and 379 with severe PE (sPE).All angiogenic factors' concentrations were significantly different (P ≤ 0.041) in HDP than in healthy pregnancy. In addition, these factors were markedly different in sPE than in mPE, sGH, or mGH (P ≤ 0.027) and in patients with sGH that in those with mPE or mGH (P < 0.05). As compared to mGH and mPE, patients with sGH and sPE had higher rates of both preterm delivery at <34 weeks of gestation and small-for-gestational age infants. Moreover, patients with sPE had higher rates of adverse maternal outcomes (P < 0.001) when compared to patients with mGH, sGH, or mPE. In all cases, levels of sFlt-1/PlGF ratio were significantly higher in patients with sGH and sPE who had adverse perinatal and maternal outcomes than in those with sGH and sPE who did not (P ≤ 0.016).Circulating concentrations of angiogenic factors appear to be suitable markers to assess the severity of GH and PE, and adverse outcomes.

Protein and cholesterol electrophoresis of plasma samples from captive cownose ray (Rhinoptera bonasus).

Our study was undertaken to assess the application of semiautomated methods available at the reference laboratory level for the evaluation of plasma protein and cholesterol via electrophoresis in samples from cownose rays (Rhinoptera bonasus). Three groups of animals were assessed: clinically normal, clinically abnormal, and parasitized with leeches. As reported previously, the albumin band was negligible; the protein electrophoretograms were dominated by a large beta-globulin fraction. While the group of samples from the leech-parasitized rays did not show any large differences, the abnormal group exhibited significantly elevated total solids and cholesterol levels. The latter was related to a significant increase in very low density lipoprotein levels. The results demonstrate the potential application of these laboratory methods in quantitation of plasma proteins and cholesterol fractions in subclass Elasmobranchii.

Assessment of hemoglobin binding protein in loggerhead sea turtles (Caretta caretta) undergoing rehabilitation.

The acute phase response is an important component of the early reaction of the immune system to insults including infection, inflammation, trauma, neoplasia, and stress. Acute phase proteins are valuable prognostic indicators in many mammalian species but have been poorly studied in reptiles thus far. This study examined 18 paired samples from loggerhead sea turtles (Caretta caretta) for changes observed during the rehabilitation period. Analyses performed included packed cell volume (PCV), hemoglobin binding protein, and plasma protein electrophoresis. Significant differences were observed in all of the protein electrophoresis values. Notably, the concentration of hemoglobin binding protein (as determined by a haptoglobin assay) increased in conjunction with rising total protein (by refractometry) and PCV. The results indicate that this assay may have the potential to be a useful tool in assessing the health of sea turtles.

Evaluación de los recursos de información en el Centro de Estudio, Documentación e Información de Medicamentos, Villa Clara / Assessment of information resources in the Center of Study, Documentation and Drug Information in Villa Clara province

Objetivo: evaluar los recursos de información disponibles en el Centro de Estudio, Documentación e Información de Medicamentos (CEDIMED). Métodos: se identificaron aquellas fuentes, servicios y sistemas que pudieran llegar a alcanzar la categoría de entidad o recurso de información dentro del CEDIMED, empleando la metodología INFOMAP. Se recolectaron datos sobre el costo de los recursos identificados y se desarrolló un ordenamiento de estos según su característica. Se determinó el índice de valor para cada ERIs y se elaboraron las matrices de usuario, gerente y suministradores, lo que posibilitó conocer el rol de cada miembro de la organización con respecto a los recursos de información. Se analizó la variable fondos de información, en la que se estudiaron un total de 15 indicadores. Resultados: se identificaron 47 entidades o recursos de información disponibles en el centro; de estas 36 internas y 11 externas. Los fondos documentales con los que cuenta el CEDIMED no presentaron un alto grado de actualización; sin embargo, las temáticas contenidas en estos, resultaron altamente pertinentes a las funciones de este tipo de organización. Alrededor de la mitad de los indicadores analizados fue evaluado de excelente; sin embargo, la variable fondos de información fue regular. Conclusiones: todo centro o servicio de información sobre medicamentos debe contar con recursos de información de calidad y fácil acceso por los usuarios; así como establecer una política para el desarrollo de los fondos y la realización de estudios sobre el uso de las diversas colecciones disponibles en la institución(AU)

Objective: to evaluate the information resources available at the Center of Study, Documentation and Information on Drugs (CEDIMED). Methods: identification of those sources, services and systems that might attain the category of entity or of information resource within CEDIMED by using the INFOMAD methodology. Data on the cost of identified resources were collected and ordered according to their characteristics. The value index was determined for each ERI and the user, manager and supplier matrices were prepared, all of which made it possible to know the role of each member of the organization in relation to the information resources. The variable called information stocks was analyzed including the study of 15 indicators. Results: forty seven information entities or resources were available at the center, 36 domestic and 11 external. The documentary stocks of CEDIMED were not highly updated; however, their topics were highly relevant for the functions of this type of organization. The evaluation of almost half of the analyzed indicators was excellent but the variable information stocks were rated as regular. Conclusions: every information center or service on drugs should have quality easy-to-access resources for users and should also set a policy aimed at developing the stocks and at carrying out studies on the use of the various collections located in the institution(AU)

Evaluación de los recursos de información en el Centro de Estudio, Documentación e Información de Medicamentos, Villa Clara / Assessment of information resources in the Center of Study, Documentation and Drug Information in Villa Clara province

OBJETIVO: evaluar los recursos de información disponibles en el Centro de Estudio, Documentación e Información de Medicamentos (CEDIMED). MÉTODOS: se identificaron aquellas fuentes, servicios y sistemas que pudieran llegar a alcanzar la categoría de entidad o recurso de información dentro del CEDIMED, empleando la metodología INFOMAP. Se recolectaron datos sobre el costo de los recursos identificados y se desarrolló un ordenamiento de estos según su característica. Se determinó el índice de valor para cada ERIs y se elaboraron las matrices de usuario, gerente y suministradores, lo que posibilitó conocer el rol de cada miembro de la organización con respecto a los recursos de información. Se analizó la variable fondos de información, en la que se estudiaron un total de 15 indicadores. RESULTADOS: se identificaron 47 entidades o recursos de información disponibles en el centro; de estas 36 internas y 11 externas. Los fondos documentales con los que cuenta el CEDIMED no presentaron un alto grado de actualización; sin embargo, las temáticas contenidas en estos, resultaron altamente pertinentes a las funciones de este tipo de organización. Alrededor de la mitad de los indicadores analizados fue evaluado de excelente; sin embargo, la variable fondos de información fue regular. CONCLUSIONES: todo centro o servicio de información sobre medicamentos debe contar con recursos de información de calidad y fácil acceso por los usuarios; así como establecer una política para el desarrollo de los fondos y la realización de estudios sobre el uso de las diversas colecciones disponibles en la institución(AU)

OBJECTIVE: to evaluate the information resources available at the Center of Study, Documentation and Information on Drugs (CEDIMED). METHODS: identification of those sources, services and systems that might attain the category of entity or of information resource within CEDIMED by using the INFOMAD methodology. Data on the cost of identified resources were collected and ordered according to their characteristics. The value index was determined for each ERI and the user, manager and supplier matrices were prepared, all of which made it possible to know the role of each member of the organization in relation to the information resources. The variable called information stocks was analyzed including the study of 15 indicators. RESULTS: forty seven information entities or resources were available at the center, 36 domestic and 11 external. The documentary stocks of CEDIMED were not highly updated; however, their topics were highly relevant for the functions of this type of organization. The evaluation of almost half of the analyzed indicators was excellent but the variable information stocks were rated as regular. CONCLUSIONS: every information center or service on drugs should have quality easy-to-access resources for users and should also set a policy aimed at developing the stocks and at carrying out studies on the use of the various collections located in the institution(AU)

Acute phase protein expression during elephant endotheliotropic herpesvirus-1 viremia in Asian elephants (Elephas maximus).

Infection of Asian elephants (Elephas maximus) with elephant endotheliotropic herpesvirus (EEHV) can be associated with rapid, lethal hemorrhagic disease and has been documented in elephant herds in human care and in the wild. Recent reports describe real-time quantitative polymerase chain reaction (qPCR) assays used to monitor clinically ill elephants and also to detect subclinical EEHV1 infection in apparently healthy Asian elephants. Acute phase proteins have been demonstrated to increase with a variety of infectious etiologies in domesticated mammals but have not yet been described in elephants. In addition, the immune response of Asian elephants to EEHV1 infection has not been described. In this study, whole blood and trunk wash samples representing repeated measures from eight elephants were examined for the presence of EEHV1 using a qPCR assay. Elephants were classified into groups, as follows: whole blood negative and positive and trunk wash negative and positive. Serum amyloid A (SAA) and haptoglobin (HP) levels were compared between these groups. A significant difference in SAA was observed with nearly a threefold higher mean value during periods of viremia (P=0.011). Higher values of SAA were associated with >10,000 virus genome copies/ml EEHV1 in whole blood. There were no significant differences in HP levels, although some individual animals did exhibit increased levels with infection. These data indicate that an inflammatory process is stimulated during EEHV1 viremia. Acute phase protein quantitation may aid in monitoring the health status of Asian elephants.

Extrofia vesical: una anomalía congénita / Vesical Exstrophy: a Case Presentation

Se realizó un trabajo descriptivo y representativo de un caso, para el que se utilizó la entrevista, la ultrasonografía y la evaluación del grupo Multidisciplinario de Genética Provincial. La paciente con 23 años de edad, con historia obstetricia de G2 P1 eutócico, clasificado de riesgo genético bajo, se le detectó en el ultrasonido del segundo semestre en la semana de gestación 19.6 una anomalía congénita, diagnosticada como extrofia vesical. Después de encontrado este hallazgo, la gestante fue remitida al Centro Genético Provincial. El equipo facultativo evaluó el caso y decidió la interrupción electiva del embarazo, siendo un feto de 450 gramos del sexo femenino. El resultado final de la anatomía patológica fue: ausencia de fusión del hueso pelviano; malformación de la vulva, clítoris prominente, labios mayores cortos y abiertos; vejiga insertada en la pared abdominal (AU)

A descriptive and representative research on a case was performed where the medical interview, the ultrasonography and the assessment of the Provincial Multidisciplinary Group of Genetics were used. The patient was 23 years old and had an obstetric history of eutectic G2 P1; ranked as a low genetic risk. A congenital anomaly was detected by the second term ultrasound of the 19.6 week of gestation. It was diagnosed as a vesical exstrophy. After finding this, the pregnant woman was referred to the Provincial Genetics Center where the medical team assessed the case and decided an elective termination of the pregnancy. It was a female fetus of 450 grams. The final pathological result was: absence of pelvic bone fusion, malformation of the vulva, prominent clitoris, short and open labia majora and a bladder inserted into the abdominal wall (AU)

Randomized trial of transversus abdominis plane block at total laparoscopic hysterectomy: effect of regional analgesia on quality of recovery.

OBJECTIVE: The objective of the study was to determine whether transversus abdominis plane (TAP) block improves the early postoperative quality of recovery (QoR-40). The secondary objectives measured postoperative pain, length of stay, and narcotic use. STUDY DESIGN: This was a randomized, single-blinded trial of TAP block versus no block on women undergoing laparoscopic hysterectomy. TAP block patients received 20 mL of 0.5% ropivacaine with epinephrine 1:200,000 placed under ultrasound guidance on each side. The outcomes were measured using validated quality of recovery questionnaires (QoR-40), visual analog scales (VAS) for pain, and documented narcotic use in the electronic medical record. RESULTS: In 58 women, no differences in demographics were noted between groups. Comparisons of pain and recovery between the 2 groups showed no differences. There was no decrease in narcotic use or length of stay among those who received the TAP block. CONCLUSIONS: TAP block does not improve postoperative QoR-40 scores or VAS pain scores following laparoscopic hysterectomy, nor does it decrease narcotic pain medication use.

Effect of an iPod video intervention on consent to donate organs: a randomized trial.

BACKGROUND: The gap between the supply of organs available for transplantation and demand is growing, especially among ethnic groups. OBJECTIVE: To evaluate the effect of a video designed to address concerns of ethnic groups about organ donation. DESIGN: Cluster randomized, controlled trial. Randomization was performed by using a random-number table with centralized allocation concealment. Participants and investigators assessing outcomes were not blinded to group assignment. (ClinicalTrials.gov registration number: NCT00870506) SETTING: Twelve branches of the Ohio Bureau of Motor Vehicles in northeastern Ohio. PARTICIPANTS: 952 participants aged 15 to 66 years. INTERVENTION: Video (intervention; n = 443) or usual Bureau of Motor Vehicles license practices (control; n = 509). MEASUREMENTS: The primary outcome was the proportion of participants who provided consent for organ donation on a newly acquired driver's license, learner's permit, or state identification card. Secondary outcomes included willingness to make a living kidney donation to a family member in need and personal beliefs about donation. RESULTS: More participants who viewed the video consented to donate organs than control participants (84% vs. 72%; difference, 12 percentage points [95% CI, 6 to 17 percentage points]). The video was effective among black participants (76% vs. 54%; difference, 22 percentage points [CI, 9 to 35 percentage points]) and white participants (88% vs. 77%; difference, 11 percentage points [CI, 5 to 15 percentage points]). At the end of the trial, fewer intervention than control participants reported having insufficient information about organ donation (34% vs. 44%; difference, -10 percentage points [CI, -16 to -4 percentage points]), wanting to be buried with all of their organs (14% vs. 25%; difference, -11 percentage points [CI, -16 to -6 percentage points]), and having conflicts with organ donation (7% vs. 11%; difference, -4 percentage points [CI, -8 to -2 percentage points]). LIMITATION: How the observed increases in consent to donate organs might translate into a greater organ supply in the region is unclear. CONCLUSION: Exposure to a brief video addressing concerns that ethnic groups have about organ donation just before obtaining a license, permit, or identification card increased consent to donate organs among white and black participants. PRIMARY FUNDING SOURCE: National Institutes of Health and the Robert Wood Johnson Foundation.