Medical Student Decision-Making: Standard Surgical Excision or Mohs Micrographic Surgery to Manage Basal Cell Carcinoma.

CONTEXT: As future physicians, osteopathic medical students will play a critical role in helping patients make informed decisions regarding treatment options. OBJECTIVE: To examine the influence that the time, cost, and cosmetic effects associated with treatment options for basal cell carcinoma (BCC), along with students' demographic characteristics, have on treatment decision-making. The influence that different sources of information have on students was also studied. METHODS: Medical students were recruited from the Nova Southeastern University College of Osteopathic Medicine for this cross-sectional study. Students were presented with a case scenario in which they were a patient with primary nodular BCC in a low-risk zone, and they were asked to select standard surgical excision (SSE) or Mohs micrographic surgery (MMS) as a treatment option. They also completed an anonymous survey that assessed the way that factors associated with the treatment options (time, cost, and cosmetic effects) influenced their treatment choice, along with the influence that different sources of information have. Measures of central tendency, frequencies, and other descriptive analyses were used to define the characteristics of the sample. χ2 analysis, correlational analysis, and t tests were used to examine the associations between the treatment decision, treatment-related factors (time, cost, cosmetics), and year in medical school. Statistical significance was set at P≤.05. RESULTS: A total of 450 students completed the survey and were included in the bivariate analysis. Three hundred forty-five students (76.7%) selected MMS as a treatment option and 105 (23.3%) selected SSE. Significant differences were found in the influence of time, cost, and cosmetic effects associated with treatment between students who selected MMS and those who selected SSE (P<.001). Cost played a more influential role in treatment decision-making for students who selected SSE than for those who selected MMS. Time and cosmetic effects played a more influential role in treatment choice for those who selected MMS. The most influential sources of information were health care professionals and medical literature, with 398 (88.4%) and 313 (69.6%) students, respectively, indicating that these sources were highly influential when making medical treatment decisions. The internet had a low influence over students' treatment decision-making (238 [52.9%]). CONCLUSIONS: This study represents an initial step toward understanding factors that influence patients' treatment decision-making in a situation in which there is no medically preferred treatment option. The findings point to the importance of time, cost, and cosmetics as influential factors for patients choosing between different treatment options.

Examining the factors associated with past and present dermoscopy use among family physicians.

INTRODUCTION: Family physicians (FPs) play a critical role in the early detection of skin cancers. Dermoscopy can improve diagnostic accuracy but its use by FPs in the United States (US) remains understudied. OBJECTIVES: To examine dermoscopy use, factors associated with ever having used (Model 1) and currently using the dermascope (Model 2), and barriers. METHODS: We recruited 705 practicing FPs in-person at conferences and on-line to complete an anonymous, 46 item survey measuring: demographic factors, physician and practice characteristics; confidence in differentiating skin lesions; knowledge and use of dermoscopy; intentions to use; and barriers to use. We conducted bivariate analysis for each outcome and entered the significant predictors into two logistic regressions. RESULTS: Almost 20% had ever used a dermascope and 8.3% were currently using it. Ever having used a dermascope was associated with being 39 years of age or younger, practicing in academia or community centers, and having higher confidence differentiating skin lesions. Current use was associated with seeing more than 400 patients per month and being 60 years-of-age or older. CONCLUSION: Use of dermoscopy by FPs is low. This study is an initial step in understanding its use among US FPs.

Use of and intentions to use dermoscopy among physicians in the United States.

BACKGROUND: Dermatologists routinely use dermoscopy to improve diagnostic accuracy of skin cancers. Much less is known about its use among other physicians who routinely examine the skin, such as family physicians, internists and plastic surgeons. OBJECTIVES: To document the use of dermoscopy in a sample of US physicians and to examine physician and practice characteristics associated with ever having used a dermascope and having some intentions to incorporate dermoscopy into clinical practice during the next 12 months. METHODS: From September 2015 to February 2016, we recruited 1,466 practicing physicians in person and online to complete an anonymous survey that assessed: demographic factors; physicians and practice characteristics; confidence differentiating skin lesions; knowledge and use of dermoscopy; and intentions and barriers to use dermoscopy. We conducted bivariate analysis to examine the relationship between key factors and the outcomes and entered the significant predictors into two separate logistic regressions. RESULTS: Fifteen percent of participants had ever used a dermascope and 6% were currently using it. Factors significantly associated with ever having used a dermascope (Model 1) and having intentions to use (Model 2) at the multivariate level were: recent graduation from medical school (strongest predictor in both models), identifying as a family physician, seeing a higher number of patients with skin cancer and having a higher level of confidence differentiating skin lesions. Both models were highly significant. CONCLUSION: Use of dermoscopy was low. Promotional efforts to increase dermoscopy use in the US are needed.

Predictors of Sunburn Risk Among Florida Residents.

CONTEXT: The incidence of skin cancer, the most common type of cancer in the United States, is increasing. Sunburn is a major modifiable risk factor for skin cancer, and its prevalence among the US population is high. OBJECTIVES: To identify predictors of having had a red or painful sunburn in the past 12 months among people living in Florida. METHODS: Florida residents were recruited from public places and online. They were asked to complete an anonymous cross-sectional survey that assessed demographic information, dermatologic history, as well as knowledge, attitude, and behavior factors associated with sunburn. RESULTS: A total of 437 participants whose data were complete for all variables were included in the multivariate analysis. In multivariate logistic regression, younger age (18-29 years) was the most significant predictor of sunburn (OR, 15.26; 95% CI, 5.97-38.98; P<.001). Other significant predictors included identifying as nonwhite (OR, 0.51; 95% CI, 0.29-0.90; P<.02), having had a full-body skin examination by a physician (OR, 1.8; 95% CI, 1.03-3.14; P<.04), reporting higher levels of skin sensitivity to the sun (OR, 4.63; 95% CI, 2.07-10.34; P<.001), having a less favorable attitude toward sun protection (OR, 0.88; 95% CI, 0.81-0.94; P<.001), having high perceived vulnerability to skin cancer (OR, 1.21; 95% CI, 1.05-1.41; P<.009), and spending less than 1 hour outside between 10 am and 4 pm on weekends (OR, 0.46; 95% CI, 0.22-0.96; P<.04). The model was statistically significant at P<.001 and correctly classified 78% of participants. CONCLUSIONS: Sunburn prevention programs that osteopathic physicians can readily implement in clinical practice are urgently needed, particularly for young adult patients. This study identified 7 predictors of sunburn in Florida residents. With additional research findings, promoting attitude change toward sun protection may be a viable strategy.

Dermascope Use by Osteopathic Primary Care Physicians.

CONTEXT: Osteopathic physicians (ie, DOs) in primary care may play a critical role in the early detection of skin cancer. Dermoscopy improves diagnostic accuracy; however, its use among primary care DOs remains understudied. OBJECTIVES: To document dermascope use among DOs in primary care, to examine physician and practice characteristics associated with having used and having heard of a dermascope, and to examine the barriers to dermascope use. METHODS: Osteopathic physicians were recruited to complete an anonymous survey assessing demographic factors, physician and practice characteristics, confidence in differentiating skin lesions, knowledge and dermascope use, and barriers to dermascope use. Bivariate analyses were conducted, and the significant factors were entered into 2 separate logistic regressions. RESULTS: A total of 768 participants were included in the study. Four hundred ten (54%) had heard of a dermascope, and 123 (15%) had used one. The statistically significant multivariate predictors for having used a dermascope (model 1) were graduating from medical school after 1989 and having greater confidence in differentiating skin lesions (OR, 2.2; 95% CI, 1.66-2.79). Those who graduated after 2009 were 9.5 times more likely and those graduating between 2000 and 2009 were 4.3 times more likely to have used a dermascope than those graduating before 1990 (95% CI, 4.29-20.90 and 95% CI, 2.04-9.23, respectively). Ever having heard of a dermascope (model 2) was associated with being female (OR, 1.4; 95% CI, 1.02-1.87); practicing in a group (OR, 1.6; 95% CI, 1.05-2.36), academic (OR, 2.2; 95% CI, 1.26-3.86), or community center (OR, 2.2; 95% CI, 1.20-4.00); and having greater confidence in differentiating skin lesions (OR, 1.3; 95% CI, 1.15-1.55). Both models were statistically significant and correctly classified 605 (84.1%) (model 1) and 444 (58.4%) participants (model 2). CONCLUSION: Dermascope use could help primary care DOs improve their diagnostic accuracy for skin cancer and reduce unnecessary referrals to specialists. Efforts to disseminate knowledge about the benefits of using a dermascope to primary care DOs are needed.

A Randomized Controlled Trial of POWER: An Internet-Based HIV Prevention Intervention for Black Bisexual Men.

POWER is a theory-based, on-line HIV prevention intervention developed specifically for Black men who have sex with men and women (BMSMW), an understudied group significantly impacted by HIV. To test its efficacy, we recruited 224 BMSMW using chain referral methods and randomly assigned 108 to POWER and 103 to a health information comparison condition. Three months after the intervention, participants assigned to POWER had lower odds of reporting any condomless vaginal or condomless anal intercourse (CVAI) compared to those in the comparison group (aOR = 0.49; 95 % CI 0.25-0.98; p = 0.044). The intervention was associated with significantly lower odds of condomless anal intercourse with male partners (aOR = 0.55; 95 % CI 0.34-0.91; p = 0.020) but not with female partners and serodiscordant sex with male partners but not with female partners. Future studies are needed to replicate these findings in larger and more diverse samples of BMSMW and to understand the underlying mechanisms through which intervention efficacy was achieved.

Predictors of scoring at least 600 on COMLEX-USA Level 1: successful preparation strategies.

CONTEXT: Comprehensive Osteopathic Medical Licensing Examination-USA (COMLEX-USA) Level 1 scores are an important criterion used by residency directors to make residency placement decisions. OBJECTIVE: To explore the association between scoring at least 600 on COMLEX-USA Level 1 and grade point average (GPA), scores on the Medical College Admission Test (MCAT), and different test preparation strategies. METHODS: Third-year osteopathic medical students at Nova Southeastern University were invited to complete a self-administered survey regarding their COMLEX-USA preparation strategies and to provide consent for the researchers to access their preclinical GPA and their MCAT and COMLEX-USA scores. Descriptive analyses were conducted to understand examination preparation procedures and resources used, and bivariate analyses were conducted to identify the statisically significant predictors of scoring 600 or higher. Two separate logistic regressions were also run. The first included all of the statisically significant factors that emerged from the bivariate analyses, and the second examined which candidate predictors remained statistically significant once the effects of GPA and MCAT scores were removed. RESULTS: One hundred twenty-two students completed the survey, and 113 (93%) provided informed consent to access their preclinical GPA and their MCAT and COMLEX-USA scores. In the first regression, scoring 600 or higher was associated with a higher GPA (P<.02), a higher MCAT score (P<.05), earlier preparation initiation (P<.05), and not ranking the Comprehensive Osteopathic Medical Self-Assessment Examination (COMSAE) as the most helpful practice examination (P<.04). In the second regression, scoring 600 or higher was associated with earlier initiation of examination preparation (P<.01) and not ranking COMBANK (question bank for COMLEX-USA) as the most helpful question bank (P<.03). Among the different examination preparation methods, the specific resources ranked as most helpful were First Aid for the USMLE (United States Medical Licensing Examination) (review book), the COMSAE (practice examination); COMBANK (question bank); and Kaplan USMLE (lecture videos). CONCLUSION: Preclinical GPA and MCAT scores continue to be important predictors of scoring at least 600 on COMLEX-USA Level 1. However, the findings underscore the importance of maintaining a high GPA during the first 2 years of medical school and initiating COMLEX-USA preparation early.

Efecto del D-002 sobre la úlcera inducida por aspirina asociada al infiltrado de neutrófilos en la mucosa gástrica / s. t

Introduction: the gastric mucosa is susceptible to the effects of aggressive factors, which are counterbalanced by mucosal defensive factors. Acid peptic diseases result from the imbalance between these aggressive and defensive factors. Aspirin-induced ulcer is a model of NSAIDs-induced damage in which neutrophil infiltration plays a key role. Objective: this paper investigates the protective effect of D-002 against aspirin-induced ulcers and associated neutrophil infiltration in the gastric mucosa. Methods: rats were randomized into six groups of 8 rats each. A negative vehicle control, and five aspirin (300 mg/kg)-treated groups: a positive control, orally treated with the vehicle, three with D-002 (25, 50 and 100 mg/kg, respectively) and other with 10 mg/kg Omeprazole. Five hours after induced damage the rats were sacrificed. The stomachs were removed and opened, and lesions examined macroscopically and microscopically. Ulcer indexes and neutrophil infiltration per ulcer areas were measured. Results: all positive, none negative, controls exhibited aspirin-induced ulcers. Oral treatment with D-002 (25-100 mg/kg) dose-dependently and significantly reduced aspirin-induced gastric lesions (37 to 75 ), the mean number of microscopic ulcers (40 to 72 por ciento) and neutrophil infiltration (41.7 to 83.1 por ciento) in the rat gastric mucosa. Conclusion: Oral treatment with D-002 (25-100 mg/kg) effectively protects against aspirin-induced ulcers and decreases the neutrophil infiltration in the gastric mucosa induced by aspirin ulceration(AU)

Introducción: la integridad de la mucosa gástrica depende del balance entre los factores agresivos y defensivos. La úlcera inducida por aspirina es un modelo de daño por antiinflamatorios no esteroidales en el cual el infiltrado de neutrófilos desempeña una función fundamental. Objetivo: evaluar el efecto protector del D-002 sobre la úlcera inducida por aspirina asociada al infiltrado de neutrófilos en la mucosa gástrica. Métodos: las ratas fueron aleatorizadas en seis grupos de ocho animales cada uno. Un control negativo con vehículo y cinco grupos tratados con aspirina (300 mg/kg): un control positivo, tratado por vía oral con vehículo, tres grupos con D-002 (25, 50 and 100 mg/kg respectivamente) y otro con omeprazol 10 mg/kg. Cinco horas después de inducido el daño las ratas fueron sacrificadas y se extrajeron sus estómagos para su análisis morfológico. Se determinó el índice de úlcera, el número de úlceras microscópicas y el número de neutrófilos por área ulcerada. Resultados: todos los controles positivos y ninguno negativo mostraron lesiones en la mucosa. El tratamiento por vía oral con D-002 (25-100 mg/kg) redujo de modo significativo y dependiente de la dosis el índice de úlceras gástricas (37-75 percent), el promedio de úlceras microscópicas (40- 72 percent) y la infiltración de neutrófilos (41,7-83,1 percent) en la mucosa de las ratas. Conclusiones: el tratamiento por vía oral con D-002 (25-100 mg/kg) protege la mucosa gástrica de las ratas del daño inducido por aspirina, lo que disminuye el índice de úlcera y el infiltrado de neutrófilos(AU)

Effects of D-002 on aspirin-induced ulcers and neutrophil infiltration on the gastric mucosa / Efecto del D-002 sobre la úlcera inducida por aspirina asociada al infiltrado de neutrófilos en la mucosa gástrica

Introduction: the gastric mucosa is susceptible to the effects of aggressive factors, which are counterbalanced by mucosal defensive factors. Acid peptic diseases result from the imbalance between these aggressive and defensive factors. Aspirin-induced ulcer is a model of NSAIDs-induced damage in which neutrophil infiltration plays a key role. Objective: this paper investigates the protective effect of D-002 against aspirin-induced ulcers and associated neutrophil infiltration in the gastric mucosa. Methods: rats were randomized into six groups of 8 rats each. A negative vehicle control, and five aspirin (300 mg/kg)-treated groups: a positive control, orally treated with the vehicle, three with D-002 (25, 50 and 100 mg/kg, respectively) and other with 10 mg/kg Omeprazole. Five hours after induced damage the rats were sacrificed. The stomachs were removed and opened, and lesions examined macroscopically and microscopically. Ulcer indexes and neutrophil infiltration per ulcer areas were measured. Results: all positive, none negative, controls exhibited aspirin-induced ulcers. Oral treatment with D-002 (25-100 mg/kg) dose-dependently and significantly reduced aspirin-induced gastric lesions (37 to 75 ), the mean number of microscopic ulcers (40 to 72 por ciento) and neutrophil infiltration (41.7 to 83.1 por ciento) in the rat gastric mucosa. Conclusion: Oral treatment with D-002 (25-100 mg/kg) effectively protects against aspirin-induced ulcers and decreases the neutrophil infiltration in the gastric mucosa induced by aspirin ulceration

Introducción: la integridad de la mucosa gástrica depende del balance entre los factores agresivos y defensivos. La úlcera inducida por aspirina es un modelo de daño por antiinflamatorios no esteroidales en el cual el infiltrado de neutrófilos desempeña una función fundamental. Objetivo: evaluar el efecto protector del D-002 sobre la úlcera inducida por aspirina asociada al infiltrado de neutrófilos en la mucosa gástrica. Métodos: las ratas fueron aleatorizadas en seis grupos de ocho animales cada uno. Un control negativo con vehículo y cinco grupos tratados con aspirina (300 mg/kg): un control positivo, tratado por vía oral con vehículo, tres grupos con D-002 (25, 50 and 100 mg/kg respectivamente) y otro con omeprazol 10 mg/kg. Cinco horas después de inducido el daño las ratas fueron sacrificadas y se extrajeron sus estómagos para su análisis morfológico. Se determinó el índice de úlcera, el número de úlceras microscópicas y el número de neutrófilos por área ulcerada. Resultados: todos los controles positivos y ninguno negativo mostraron lesiones en la mucosa. El tratamiento por vía oral con D-002 (25-100 mg/kg) redujo de modo significativo y dependiente de la dosis el índice de úlceras gástricas (37-75 percent), el promedio de úlceras microscópicas (40- 72 percent) y la infiltración de neutrófilos (41,7-83,1 percent) en la mucosa de las ratas. Conclusiones: el tratamiento por vía oral con D-002 (25-100 mg/kg) protege la mucosa gástrica de las ratas del daño inducido por aspirina, lo que disminuye el índice de úlcera y el infiltrado de neutrófilos

Development of an easy to use tool to assess HIV treatment readiness in adolescent clinical care settings.

Optimal management of HIV disease requires high levels of lifelong adherence once a patient initiates highly active antiretroviral therapy (HAART). Because suboptimal adherence to HAART is associated with adverse consequences, many providers are hesitant to prescribe HAART for patients whom they perceive as not being ready to initiate treatment. Accurately predicting HIV treatment readiness is challenging. Despite the importance of this construct, few reliable and valid instruments to assess HIV treatment readiness have been developed; none of these have been validated with adolescents and young adults, who comprise an increasing proportion of new HIV cases diagnosed. As a first step to achieve this goal, we developed the HIV Treatment-Readiness Measure (HTRM) for administration by way of audio computer-assisted self-interview (ACASI) and conducted a study to examine its internal consistency, test-retest reliability, acceptability, and preliminary factor structure. We recruited 201 adolescents and young adults living with HIV from 15 adolescent medicine clinics that were part of the Adolescent Trials Network for HIV Interventions. Youth completed the initial assessment and two weeks later the retest assessment. The refined HTRM had high internal consistency (α = 0.84). Test-retest reliability using both sum scores and mean scores were high. The HTRM was also highly acceptable and feasible to use in routine clinical practice. In exploratory factor analysis we found that a five-factor solution was the best fit; each of the subscales (Disclosure, Psychosocial Issues, Connection with Care, HIV Medication Beliefs, and Alcohol and Drugs) had good to acceptable alphas and eigenvalues greater than 2.0. Our findings support conducting a future study to examine the tool's predictive validity.

Crystal methamphetamine: a source of added sexual risk for Hispanic men who have sex with men?

OBJECTIVES: To determine whether use of crystal methamphetamine increases HIV risk behaviors beyond the risk associated with use of other recreational drugs among Hispanic men who have sex with men (HMSM). DESIGN: We compared the sexual behaviors and psychosocial characteristics of non-recreational drug users (non-users), recreational drug users who did not use crystal (non-crystal drug users), and recreational drug users who used crystal (crystal users). METHODS: We recruited 294 HMSM from Internet and 272 from community venues. Eligible men completed an ACASI to assess socio-demographic factors, drug use, sexual behaviors and psychosocial factors and received 50 dollars. RESULTS: In the multivariate model, crystal users were more likely than non-crystal drug users to have lower Hispanicism, higher attachment to the gay community, and history of suicide attempts. Crystal users were not significantly different from non-crystal drug users in number of sex partners; however, differences in unprotected receptive anal sex approached significance. CONCLUSIONS: The additional risk of crystal above that of other recreational drugs needs to be disentangled from those associated with poly-drug use. Our data suggest that it may depend on how one defines risky sexual behavior and is influenced by psychological, physiologic and social factors.

Cruising in cyber space: comparing Internet chat room versus community venues for recruiting Hispanic men who have sex with men to participate in prevention studies.

Difficulties with recruitment of hidden populations, such as Hispanic men who have sex with men (MSM), have hampered HIV prevention research, leading researchers to explore alternative recruitment modalities such as the Internet. In this paper, we compare the efficiency and cost of recruiting HMSM from Internet chat rooms versus community venues and examine the differences between participants recruited from each type of venue. Internet recruitment was more efficient and somewhat less costly than community recruitment. Although the two groups were comparable in most demographic factors and HIV risk behaviors, Internet recruits were more likely to be bisexual, more likely to be HIV seropositive, had a higher level of education, and reported higher levels of psychological distress and lower levels of gay community attachment. Implications of our findings for using Internet chatrooms as recruitment venues are discussed.

High rates of club drug use and risky sexual practices among Hispanic men who have sex with men in Miami, Florida.

This study measured use of club drugs among 262 Hispanic men who have sex with men (MSM) recruited at community venues in Miami-Dade County, Florida in 2001. More than 50% of men used club drugs, and 36% used them in the last 3 months. Lifetime and 3-month rates were: ecstasy (36% and 20%), cocaine (34% and 12%), amyl nitrates (28% and 9%), and crystal methamphetamine (20% and 15%). Thirty-six percent had used two or more drugs (polydrug use) in their lifetime and 20% reported polydrug use in the last 3 months. Club drug users had significantly more sex partners in the last 12 months than nonclub drug users. High rates (35%) of unprotected anal sex in the last 3 months were reported by both groups. Men who reported polydrug use in the last 3 months were significantly more likely than men who used a single club drug to have had sex under the influence of club drugs (83% vs. 57%; X2=7.4, p=0.006). At the multivariate level, a significant association between preference for use of English and lifetime club drug use emerged. Effective interventions to reduce club drug use and risky sex for Hispanic MSM are needed.

Surfing new territory: club-drug use and risky sex among Hispanic men who have sex with men recruited on the Internet.

The Internet presents unique and growing opportunities for conducting HIV/ STD research. This article reports on the first 171 participants enrolled in an ongoing study examining use of the Internet to recruit Hispanic men who have sex with men (HMSM) living in an AIDS epicenter to participate in community-based studies. First, it describes initial success with chatroom recruitment. Second, it compares the demographic, psychosocial, and sexual risk practices among HMSM recruited through the Internet who had used club drugs in the last 6 months and those who had not. In 2 months, 211 hours were spent recruiting in chatrooms; 735 chatroom users were engaged. Researchers used a scripted dialogue to describe the study and to invite chatroom users to visit the study's community sites for screening and enrollment. One hundred and seventy-six men came to the community sites; 172 (98%) were eligible and completed an audio-computer assisted self-interview. In the last 6 months, 48.5% of the sample had used club drugs [defined as cocaine, crystal methamphetamines (crystal), amyl nitrites (poppers), Ecstasy, gamma-hydroxybutyrate (GHB), ketamine (Special K), and Viagra]. The proportion of men reporting use of each drug was: cocaine (15.8%), crystal (11.7%), poppers (31.6%), Ecstasy (14%), GHB (3.5%), Special K (3.5%), and Viagra (19.3%). In multivariate analyses, having higher number of sex partners, having higher social isolation scores, and having engaged in unprotected receptive anal intercourse were significantly associated with club-drug use. These initial findings suggest that high-risk HMSM can be successfully recruited through chatroom dialogues to participate in community-based HIV studies. The alarmingly high rates of club-drug use and risky sexual practices among HMSM underscore the need for effective HIV preventive interventions for this population.

Predictors of HIV testing and intention to test among Hispanic farmworkers in South Florida.

CONTEXT AND PURPOSE: This study examined the predictors of HIV testing and factors associated with intention to accept a free HIV test among 244 Hispanic migrant/seasonal farmworkers in South Florida. METHODS: Time and space sampling procedures were used to recruit participants in public venues. Bilingual staff interviewed eligible respondents in these settings. FINDINGS: Despite high rates of sexual risk, only 21% of respondents had been tested for HIV. The majority of those tested were females tested during prenatal care. In multivariable logistic regression analyses, being female (odds ratio [OR] = 3.73), having at least 12 years of education (OR = 4.46), earning more than $201 per week (OR = 2.76), and ever having used marijuana (OR = 3.31) were positively associated with having been tested for HIV, while not being documented (OR = 0.24) and having rated one's health as "very good" or "good" (OR = 0.42) were negatively associated with testing. The multivariable predictors of intention to accept a free HIV test were having visited a health care provider and/or an emergency room in the past 12 months (OR = 1.97), having been tested for HIV (OR = 2.36), preferring an HIV test that used a finger stick for specimen collection with results given in 30 minutes (OR = 4.47), and worrying "some" or "a lot" about getting HIV (OR = 3.64). Women (OR = 0.52) were less likely than men to intend to accept a free HIV test. CONCLUSIONS: Our findings highlight the importance of routinely offering HIV testing to sexually active individuals in high HIV prevalence areas. They also suggest the need to make testing more accessible to migrant and seasonal farmworkers.

Predictors of HIV risk among Hispanic farm workers in South Florida: women are at higher risk than men.

This study examined factors associated with being at risk of sexually acquiring HIV among a community sample of 244 Hispanic migrant and seasonal farm workers. Bilingual staff interviewed respondents anonymously at worksites, camps, and other public venues in South Florida during the 2002 winter/spring growing season. The following variables were positively associated with being at risk of sexually acquiring HIV in multivariable analyses: being female; being married; having "some" or "a lot" of knowledge about HIV transmission, having ever used marijuana, having two or more sex partners in the last 12 months, and having had a sexually transmitted infection. The findings heighten the importance of recognizing women's elevated risk of HIV infection and conducting further studies to examine the factors associated with this increased risk. The study is an important first step toward developing tailored HIV prevention interventions for this at-risk, understudied population.

Enfoque interdisciplinario sobre el uso de plaguicidas de empleo común en el hogar, en la localidad de Fray Luis Beltran

Con el objeto de promover acciones tendientes a evitar intoxicaciones y contaminaciones provenientes del mal uso de plaguicidad para el hogar se realizó el presente estudio en una localidad de la provincia de Santa Fe, Fray Luis Beltrán. Además se trata de modificar la Ley vigente en la Provincia que regula todo lo relacionado a plaguicidas agropecuarios e industriales conexceción de los domiciliarios

Interaction of third generation cephalosporins combined with amikacin against Pseudomona aeruginosa

Se estudió la actividad in vitro de cefoperazone, cefotaxime, moxalactam y ceftizoxime individualmente y en combinación con amikacin en contra de 20 cepas de Pseudomonas aeruginosa obtenidas de la sangre de pacientes. Ceftizoxime-amikacin resultó ser la combinación más sinergística (85%) utilizando el índice de la concentración inhibitoria fraccionada (FIC index). Sin embargo, si analizamos el efecto de la combinación de los antibióticos en la concentración mínima inhibitoria (MIC) en contra de Pseudomonas aeruginosa, la combinación más activa in vitro lo fue cefoperazone-amikacin. Esta aparente discrepancia en los resultados puede traer confunsión si no entendemos las metodologías utilizadas y lo que cada un significa. Es nuestro interés alertar al clínico y que tenga cuidado cuando utiliza el criterio de sinergismo para dirigir su terapia

Interaction of third generation cephalosporins combined with amikacin against Pseudomonas aeruginosa

Se estudió la actividad in vitro de cefoperazone, cefotaxime, moxalactam y ceftizoxime individualmente y en combinación con amikacin en contra de 20 cepas de Pseudomonas aeruginosa obtenidas de la sangre de pacientes. Ceftizoxime-amikacin resultó ser la combinación más sinergística (85%) utilizando el índice de la concentración inhibitoria fraccionada (FIC index). Sin embargo, si analizamos el efecto de la combinación de los antibióticos en la concentración mínima inhibitoria (MIC) en contra de Pseudomonas aeruginosa, la combinación más activa in vitro lo fue cefoperazone-amikacin. Esta aparente discrepancia en los resultados puede traer confusión si no entendemos las metodologías utilizadas y lo que cada una significa. Es nuestro interés alertar al clínico cuando utiliza del criterio de sinergismo para dirigir su terapia