Implementation of Group Interpersonal Psychotherapy in primary care.

OBJECTIVE: To show the implementation process of IPT-G in primary care, including facilitating and obstructing factors, implementation strategies, and training and supervision of primary care professionals. METHODS: Quantitative (cross-sectional and longitudinal) analysis of pre and post-knowledge tests; qualitative analyses of the training courses; patient recruitment; conduction of IPT-G sessions; supervision of IPT-G therapists; application of a semi-structured questionnaire to assess, investigate, and develop strategies against the identified barriers. RESULTS: About 120 clinicians answered the pre-test; 84 completed the post-test. Pre- and post-test scores of IPT-G knowledge were significantly different. Twenty initially trained clinicians completed additional supervision in IPT-G. Qualitative analysis identified twelve barriers and six facilitators to IPT-G implementation in individual, organizational, and systemic contexts. CONCLUSIONS: Implementation of IPT-G in primary care is a complex process with several steps. In the first step, health professionals were successfully trained in IPT-G. However, subsequent steps were more complex. Therefore, careful planning of IPT-G implementation is essential to maximize the success of this innovation.

Implementation of Group Interpersonal Psychotherapy in primary care

ABSTRACT OBJECTIVE To show the implementation process of IPT-G in primary care, including facilitating and obstructing factors, implementation strategies, and training and supervision of primary care professionals. METHODS Quantitative (cross-sectional and longitudinal) analysis of pre and post-knowledge tests; qualitative analyses of the training courses; patient recruitment; conduction of IPT-G sessions; supervision of IPT-G therapists; application of a semi-structured questionnaire to assess, investigate, and develop strategies against the identified barriers. RESULTS About 120 clinicians answered the pre-test; 84 completed the post-test. Pre- and post-test scores of IPT-G knowledge were significantly different. Twenty initially trained clinicians completed additional supervision in IPT-G. Qualitative analysis identified twelve barriers and six facilitators to IPT-G implementation in individual, organizational, and systemic contexts. CONCLUSIONS Implementation of IPT-G in primary care is a complex process with several steps. In the first step, health professionals were successfully trained in IPT-G. However, subsequent steps were more complex. Therefore, careful planning of IPT-G implementation is essential to maximize the success of this innovation.

Combination of a six microRNA expression profile with four clinicopathological factors for response prediction of systemic treatment in patients with advanced colorectal cancer.

BACKGROUND: First line chemotherapy is effective in 75 to 80% of patients with metastatic colorectal cancer (mCRC). We studied whether microRNA (miR) expression profiles can predict treatment outcome for first line fluoropyrimidine containing systemic therapy in patients with mCRC. METHODS: MiR expression levels were determined by next generation sequencing from snap frozen tumor samples of 88 patients with mCRC. Predictive miRs were selected with penalized logistic regression and posterior forward selection. The prediction co-efficients of the miRs were re-estimated and validated by real-time quantitative PCR in an independent cohort of 81 patients with mCRC. RESULTS: Expression levels of miR-17-5p, miR-20a-5p, miR-30a-5p, miR-92a-3p, miR-92b-3p and miR-98-5p in combination with age, tumor differentiation, adjuvant therapy and type of systemic treatment, were predictive for clinical benefit in the training cohort with an AUC of 0.78. In the validation cohort the addition of the six miR signature to the four clinicopathological factors demonstrated a significant increased AUC for predicting treatment response versus those with stable disease (SD) from 0.79 to 0.90. The increase for predicting treatment response versus progressive disease (PD) and for patients with SD versus those with PD was not significant. in the validation cohort. MiR-17-5p, miR-20a-5p and miR-92a-3p were significantly upregulated in patients with treatment response in both the training and validation cohorts. CONCLUSION: A six miR expression signature was identified that predicted treatment response to fluoropyrimidine containing first line systemic treatment in patients with mCRC when combined with four clinicopathological factors. Independent validation demonstrated added predictive value of this miR-signature for predicting treatment response versus SD. However, added predicted value for separating patients with PD could not be validated. The clinical relevance of the identified miRs for predicting treatment response has to be further explored.

BUILD EXITO: a multi-level intervention to support diversity in health-focused research.

BACKGROUND AND PURPOSE: As part of the NIH BUILD initiative to diversify the scientific workforce, the EXITO project is a large multi-institutional effort to provide comprehensive support and training for undergraduates from traditionally underrepresented student populations who aspire to health-related research careers. Portland State University, a major public urban university that prioritizes student access and opportunity, and Oregon Health & Science University, a research-intensive academic health center, lead the EXITO network comprised of eleven 2-year and 4-year institutions of higher education spanning Oregon, Washington, Alaska, Hawaii, Guam, American Samoa, and the Northern Mariana Islands. The EXITO project aims for impact in biomedical research by training diverse scholars from indigenous and underserved communities affected by adverse health disparities. PROJECT APPROACH: Guided by socio-ecological theory, the EXITO project is a multi-level intervention offering a three-year research training pathway for scholars in the biomedical, behavioral, health, and social sciences. Fundamental components of the model include student outreach and engagement, integrated curricular enhancements, intensive research experiences, multi-faceted developmental mentoring, supportive community and services, and rigorous evaluation and quality improvement. EXITO also advances faculty and institutional development in these domains by holding curriculum development conferences, creating research learning communities, awarding pilot project research funding, providing mentor training and ongoing support, collaborating with other research equity programs, and developing campus infrastructure and services to support scholars with diverse backgrounds and needs. HIGHLIGHTS: The large and geographically broad network of EXITO institutions engages a range of diverse students, including indigenous populations and students beginning post-secondary education at community colleges. The EXITO model specifically accommodates many students transferring from 2-year partner institutions and facilitates seamless transfer to the 4-year institution. EXITO features several approaches to research training, including supported summer entry into research placements, the incorporation of responsible conduct of research content into general education curriculum, and the intentional matching of scholars with three types of mentors (e.g., peer, career, research). IMPLICATIONS: EXITO provides an example of a comprehensive research training initiative for traditionally underrepresented students that can be implemented across a diverse range of 2-year and 4-year institutions.

High prevalence of intratesticular varicocele in a post-orchidopexy cohort.

PURPOSE: Intratesticular varicocele (ITV) is an uncommon sonographic finding. A prevalence of up to 2% has been reported in men with testicular problems. In a cohort of men who had undergone prepubertal orchidopexy for acquired undescended testis, several cases of ITV were found. The aim of this study was to analyse the prevalence and clinical aspects of ITV in this cohort. METHODS: In a long-term follow-up study of position and growth of undescended testis after prepubertal orchidopexy, ultrasonography was used to identify men with ITV. Data on clinical presentation, testicular volume, and the location, size and Doppler aspects of intratesticular varicocele were collected and analysed. RESULTS: Of the 105 men, 9 were identified with ITV (8.6%). In all patients, the side of orchidopexy correlated with the side of the ITV, and all were left-sided. The testis with ITV had a smaller volume than the testis without ITV (p = 0.026). CONCLUSIONS: A remarkably high prevalence of ITV (8.6%) was found as well as a smaller volume of the testes with ITV in a cohort of men who had undergone prepubertal orchidopexy for acquired undescended testis.

Association between childhood trauma and loss of functionality in adult women with fibromyalgia.

OBJECTIVE: To investigate whether history of childhood trauma is associated with loss of functionality in adult women with fibromyalgia (FM). A secondary objective was to assess the presence of differences between depressed and non-depressed adult women with FM in a regression model for functionality. METHODS: A total of 114 adult women with FM according to the American College of Rheumatology diagnostic criteria answered the Childhood Trauma Questionnaire and the Fibromyalgia Impact Questionnaire. All subjects were interviewed by trained psychiatrists and evaluated for depression using the Mini International Neuropsychiatric Interview (MINI) - Brazilian version 5.0.0. Correlation and regression models were used to investigate associations between childhood trauma and loss of functionality among patients with FM. The sample was stratified by presence and absence of clinical depression. RESULTS: Overall, childhood trauma was associated with of loss of functionality in adult women with FM. When stratified by depression, the regression model significantly increased the association among non-depressed patients, even after adjustment for age and use of psychotropic medications. CONCLUSIONS: Childhood trauma showed a clinically important association with loss of functionality among adult women with FM. The associations were more pronounced among subjects without comorbid depression.

Association between childhood trauma and loss of functionality in adult women with fibromyalgia / Associação entre trauma na infância e perda de funcionalidade em mulheres adultas com fibromialgia

OBJECTIVE: To investigate whether history of childhood trauma is associated with loss of functionality in adult women with fibromyalgia (FM). A secondary objective was to assess the presence of differences between depressed and non-depressed adult women with FM in a regression model for functionality. METHODS: A total of 114 adult women with FM according to the American College of Rheumatology diagnostic criteria answered the Childhood Trauma Questionnaire and the Fibromyalgia Impact Questionnaire. All subjects were interviewed by trained psychiatrists and evaluated for depression using the Mini International Neuropsychiatric Interview (MINI) - Brazilian version 5.0.0. Correlation and regression models were used to investigate associations between childhood trauma and loss of functionality among patients with FM. The sample was stratified by presence and absence of clinical depression. RESULTS: Overall, childhood trauma was associated with of loss of functionality in adult women with FM. When stratified by depression, the regression model significantly increased the association among non-depressed patients, even after adjustment for age and use of psychotropic medications. CONCLUSIONS: Childhood trauma showed a clinically important association with loss of functionality among adult women with FM. The associations were more pronounced among subjects without comorbid depression

OBJETIVO: Investigar se a presença de história de trauma na infância está associada com perda de funcionalidade em mulheres adultas com fibromialgia (FM). Um segundo objetivo foi avaliar a presença de diferenças entre mulheres adultas deprimidas e não deprimidas com FM utilizando um modelo de regressão para funcionalidade. MÉTODOS: Um total de 114 mulheres adultas com FM de acordo com os critérios diagnósticos do American College of Rheumatology responderam o Childhood Trauma Questionnaire e o Questionário de Impacto da Fibromialgia. Todos os indivíduos foram entrevistados por psiquiatras treinados e avaliados para depressão utilizando o Mini International Neuropsychiatric Interview (MINI) - versão brasileira 5.0.0. Modelos de correlação e regressão foram utilizados para investigar associações entre trauma na infância e perda de funcionalidade em pacientes com FM. A amostra foi estratificada pela presença e ausência de depressão clínica. RESULTADOS: Em geral, o trauma na infância esteve associado com perda de funcionalidade em mulheres adultas com FM. Quando estratificadas por depressão, o modelo de regressão aumentou significativamente a associação em pacientes não deprimidos, mesmo após ajuste para idade e uso de medicação psicotrópica. CONCLUSÕES: Trauma na infância esteve associado de forma clinicamente importante à perda de funcionalidade em mulheres adultas com FM. As associações foram mais pronunciadas nos indivíduos sem depressão comórbida

Panorama nacional do ensino da psiquiatria nas escolas médicas brasileiras / An overview of the teaching of psychiatry in Brazilian medical schools

OBJETIVO: Determinar o perfil de ensino da psiquiatria nos cursos médicos brasileiros, verificando o número de professores envolvidos e suas titulações, o número de disciplinas e o enfoque predominante, material didático e local de ensino/aprendizagem. MÉTODO: O estudo foi baseado no levantamento de dados obtidos pela aplicação de questionários nas escolas médicas brasileiras que constam no site da Associação Brasileira de Educação Médica. RESULTADOS: Das 119 escolas médicas brasileiras, 85 (71 por cento) responderam à pesquisa. O número de professores psiquiatras envolvidos no ensino variou de 1 a 5 (75,3 por cento); desses, 1 a 2 (43,4 por cento) eram doutores/livres-docentes, 1 a 2 (45,8 por cento) eram mestres, e 1 a 2 (57,3 por cento) eram especialistas. Observou-se que 41,2 por cento das escolas oferecem duas disciplinas de psiquiatria, com enfoque predominantemente psicodinâmico e clínico (61,2 por cento). Em 52,9 por cento dos casos, o conteúdo programático não é desenvolvido apenas em cadeiras específicas de psiquiatria. As disciplinas oferecem, em 64,7 por cento dos casos, aulas práticas em contextos clínicos gerais. A carga horária durante o curso é de 61-90 horas-aula (26,2 por cento), e 88,9 por cento têm livros-textos básicos. Em 83,3 por cento das escolas médicas, essas disciplinas são avaliadas pelos alunos ao final das mesmas. CONCLUSÃO: Foi observada uma grande heterogeneidade nas regiões avaliadas, em pelo menos 71 por cento das escolas. Novos estudos devem aprofundar este primeiro levantamento.

OBJECTIVE: To determine the profile of psychiatric teaching in Brazilian medical schools, with a focus on the number of professors involved and their respective degrees, the number of disciplines devoted to psychiatry and the predominant approach (psychodynamic/clinical/other) adopted, the didactic materials employed and the teaching and learning facilities available. METHODS: The study was based on the collection of data via application of questionnaires at all medical schools registered with the Brazilian Association of Medical Education (Associação Brasileira de Educação Médica). RESULTS: Of the 119 Brazilian schools contacted, 85 (71 percent) returned the questionnaires. The number of professors graduated in psychiatry at each school varied from 1 to 5 (75.3 percent); of these, 1 to 2 (43.4 percent) had a PhD degree, 1 to 2 (45.8 percent) a master's degree, and 1 to 2 (57.3 percent) were specialists. The findings revealed that 41.2 percent of the schools offered two disciplines of psychiatry, with a predominantly psychodynamic/clinical approach (61.2 percent). At 52.9 percent of the schools, teaching of psychiatric topics was not restricted to the specific disciplines; 64.7 percent of the disciplines offered hands-on training in general clinical settings. Mean number of credit hours of psychiatric teaching along the medical program was 61-90 (26.2 percent), and 88.9 percent of the programs used books as the main choice for didactic purposes. At 83.3 percent of the medical schools, psychiatric teaching is graded by students at the end of each discipline. CONCLUSION: The present findings revealed an important heterogeneity in the geographic regions assessed, affecting at least 71 percent of the schools. New studies are warranted to advance the preliminary findings herein reported.

Suture-free laser-assisted vessel repair using CO2 laser and liquid albumin solder.

Numerous studies have shown that the use of proteinic solders during laser-assisted vascular anastomosis (LAVA) and repair (LAVR) can significantly increase welding strength, but these studies combined solder-mediated LAVA/R with the use of stay sutures, thereby defeating its purpose. In an in vitro study, we examined the leaking point pressures (LPPs) and histological damage profile of porcine carotid arteries following albumin solder-mediated CO(2) LAVR without the use of sutures. Longitudinal arteriotomies (9.1+/-0.8 mm in length) were sheathed with 25% liquid bovine serum albumin solder, and LAVR was performed using a micromanipulator-controlled CO(2) laser operating at 170-mW power and 1.25-mm spot size in continuous wave mode. The welding regime consisted of a transversal zigzag pass followed by one or two longitudinal zigzag passes, producing an irradiance of 13.9 W/cm(2) and energies of 10.5 J and 11.3 J per mm weld, respectively. LPPs were measured by the fluid infusion technique, and histological analysis was performed with light, fluorescence, and polarization microscopy. The LPP of the two-pass welds was 351+/-158 mmHg versus 538+/-155 mmHg for the three-pass welds. Thermal damage was confined primarily to the adventitial layers, with limited heat diffusion into the media below the solder around the coaptation interface.

25 years of laser assisted vascular anastomosis (LAVA): what have we learned?

OBJECTIVES: Laser assisted vascular anastomosis (LAVA) has been developed to a stage where clinical use is within reach. Advantages of LAVA are minimal vessel damage, faster operation and the potential for minimally invasive application. DESIGN: A Medline literature search was performed on vessel welding combined with cross-referencing. RESULTS: Four different lasers have mostly been used for LAVA, always in combination with stay sutures. The CO(2) laser has only been used in the early period. Without solder, mean leaking point pressures (LPP) of 754 mmHg (n=75) were obtained, only slightly lower than in suture controls (LPP=915 mmHg, n=82). At follow-up the percentage of aneurysms was high (overall 12% in n=486). Although Argon LAVA showed moderate success (LPP=146 mmHg, n=125), the first clinical application has been successfully performed. Diode LAVA in combination with solder and dye resulted in an acceptable LPP of 409 mmHg (n=163) in larger vessels, with a low incidence of aneurysm formation (1% in n=107). CONCLUSION: At present the diode laser is the most popular. Solder developments resulted in stronger welds and might make stay sutures redundant. The combination of CO(2) laser and solders has not been evaluated and deserves further investigation.

Use of an event recorder in the decision for pacemaker implantation in a child with syncope.

UNLABELLED: The use of a patient-triggered and automatic event recorder is documented in a 17-month-old girl presenting with paroxysmal episodes of loss of consciousness. After pacemaker implantation, the paroxysmal attacks disappeared. CONCLUSION: we recommend a more frequent use of the event recorder in the investigation of syncope, especially in small children.

O papel do sistema dopaminérgico na fobia social / The role of the dopaminergic system in social phobia

Os autores descrevem o papel do sistema dopaminérgico na fobia social. Evidências que indicam disfunçäo dopaminérgica säo descritas, e o papel da dopamina como um regulador da atividade social é discutido

Instability of symmetric couette flow in a granular gas: hydrodynamic field profiles and transport

We investigated the inelastic hard-disk gas sheared by two parallel bumpy walls (Couette flow). In our molecular dynamic simulations we found a sensitivity to the asymmetries of the initial particle positions and velocities and an asymmetric stationary state, where the deviation from (anti)symmetric hydrodynamic fields is stronger as the normal restitution coefficient decreases. For better understanding of this sensitivity we carried out a linear stability analysis of the former kinetic theoretical solution [J. T. Jenkins and M. W. Richman, J. Fluid. Mech. 171, 53 (1986)] and found it to be unstable. The effect of this asymmetry on the self-diffusion coefficient is also discussed.

Influência da separaçäo precoce na interaçäo mäe-bebê / Influence of early separation on the interaction between mother and newborn infant

O presente estudo tem como objetivo avaliar a interaçäo mäe-bebê a partir de diferentes tempos de contato no período pós-parto imediato. A idéia do estudo era a comparaçäo de dois grupos: um que seguiria a rotina do Centro Obstétrico do Hospital de Clínicas de Porto Alegre e outro ao qual se ofereceria um tempo extra de contato. Devido à ocorrência de efeito Hawthorne, perdeu-se o grupo-controle (näo houve diferença no tempo de contato das duplas em cada um dos grupos durante o período sensível). Assim, as 29 duplas que efetivamente entraram na pesquisa foram acompanhadas, sendo avaliadas as interaçöes, como um único grupo, já que o tempo extra de contato e o apoio às mäes no período de pós-parto imediato foram os mesmos, o que pode ter contribuído para os bons resultados das interaçöes. Após o primeiro, o sexto e o décimo segundo meses de vida do bebê, as duplas apresentaram, respectivamente, taxa de 95 por cento, 100 por cento e 92,8 por cento de boas e muito boas interaçöes. Investigaçöes futuras nesta área, com amostras maiores, devem ser realizadas, fornecendo outras contribuiçöes aos profissionais da saúde, gerando conhecimento capaz de auxiliar na prevençäo de doenças mentais, abandono e abuso, a baixo custo

Influencia da separacao precoce na interacao mae-bebe

O presente estudo tem como objetivo avaliar a interacao mae-bebe a partir de diferentes tempos de contato no periodo pos-parto imediato. A ideia inicial do estudo era a comparacao de dois grupos: um que seguiria a rotina do Centro Obstetrico do Hospital de Clinicas de Porto Alegre e outro ao qual se ofereceria um tempo extra de contato. Devido a ocorrencia de efeito Hawthorne, perdeu-se o grupo-controle (nao houve diferenca no tempo de contato das duplas em cada um dos grupos durante o periodo sensivel). Assim, as 29 duplas que efetivamente entraram na pesquisa foram acompanhadas, sendo avaliadas as interacoes, como um unico grupo, ja que o tempo extra de contato e o apoio as maes no periodo de pos-parto imediato foram os mesmos, o que pode ter contribuido para os bons resultados das interacoes. Apos o primeiro, o sexto e o decimo segundo mes de vida do bebe, as duplas apresentaram, respectivamente, taxa de 95 por cento, 100 por cento e 92,8 por cento de boas e muito boas interacoes. Investigacoes futuras nesta area, com amostras maiores, devem ser realizadas, fornecendo outras contribuicoes aos profissionais da saude gerando conhecimento capaz auterar na preservacao de doencas mentais, abandono e abuso, a baixo custo.