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Colombia hosts the largest number of refugees and migrants fleeing the humanitarian emergency in Venezuela, many of whom experience high levels of displacement-related trauma and adversity. Yet, Colombian mental health services do not meet the needs of this population. Scalable, task-sharing interventions, such as Group Problem Management Plus (Group PM+), have the potential to bridge this gap by utilizing lay workers to provide the intervention. However, the current literature lacks a comprehensive understanding of how and for whom Group PM+ is most effective. This mixed methods study utilized data from a randomized effectiveness-implementation trial to examine the mediators and moderators of Group PM+ on mental health outcomes. One hundred twenty-eight migrant and refugee women in northern Colombia participated in Group PM+ delivered by trained community members. Patterns in moderation effects showed that participants in more stable, less marginalized positions improved the most. Results from linear regression models showed that Group PM+-related skill acquisition was not a significant mediator of the association between session attendance and mental health outcomes. Participants and facilitators reported additional possible mediators and community-level moderators that warrant future research. Further studies are needed to examine mediators and moderators contributing to the effectiveness of task-shared, scalable, psychological interventions in diverse contexts.
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Salud Mental , Refugiados , Migrantes , Humanos , Colombia , Refugiados/psicología , Femenino , Venezuela , Adulto , Migrantes/psicología , Migrantes/estadística & datos numéricos , Persona de Mediana Edad , Adulto JovenRESUMEN
There is increasing guidance promoting the provision of mental health and psychosocial support programs to both migrant and host community members in humanitarian settings. However, there is a lack of information on the respective experiences and benefits for migrant and host community members who are participating in mental health and psychosocial support programming. We evaluated a community-based psychosocial program for migrant and host community women, Entre Nosotras, which was implemented with an international non-governmental organization in Ecuador in 2021. Data on participant characteristics and psychosocial wellbeing were collected via pre/post surveys with 143 participants, and qualitative interviews were conducted with a subset (n = 61) of participants. All quantitative analyses were conducted in STATA, and qualitative analysis was done in NVivo. Attendance was higher for host community members. Specifically, 71.4% of host community members attended 4-5 sessions, whereas only 37.4% of migrants attended 4-5 sessions (p = 0.004). Qualitative analysis shows that the intervention was less accessible for migrants due to a variety of structural barriers. However, this analysis also demonstrated that both groups of women felt a greater sense of social connectedness after participating in the program and expressed gratitude for the bonds they formed with other women. Some migrant women described negative experiences with the host community because they felt as though they could not confide in host community women and speak freely in front of them. These results underscore how the migratory context influences the implementation of mental health and psychosocial support (MHPSS) programs. As humanitarian guidelines continue to emphasize the integration of host community members and displaced persons, it is critical to account for how the same intervention may impact these populations differently.
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Intervención Psicosocial , Migrantes , Humanos , Ecuador , Femenino , Adulto , Migrantes/psicología , Migrantes/estadística & datos numéricos , Persona de Mediana Edad , Adulto Joven , Salud Mental , Accesibilidad a los Servicios de SaludRESUMEN
Research on mental health and psychosocial support (MHPSS) interventions within refugee and migrant communities has increasingly focused on evaluating implementation, including identifying strategies to promote retention in services. This study examines the relationship between participant characteristics, study setting, and reasons for intervention noncompletion using data from the Entre Nosotras feasibility trial, a community-based MHPSS intervention targeting refugee, migrant, and host community women in Ecuador and Panama that aimed to promote psychosocial wellbeing. Among 225 enrolled women, approximately half completed the intervention, with varying completion rates and reasons for nonattendance across study sites. Participants who were older, had migrated for family reasons, had spent more time in the study community, and were living in Panamá (vs. Ecuador) were more likely to complete the intervention. The findings suggest the need to adapt MHPSS interventions to consider the duration of access to the target population and explore different delivery modalities including the role of technology and cellular devices as reliable or unreliable source for engaging with participants. Engaging younger, newly arrived women is crucial, as they showed lower completion rates. Strategies such as consulting scheduling preferences, providing on-site childcare, and integrating MHPSS interventions with other programs could enhance intervention attendance.
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Salud Mental , Refugiados , Humanos , Femenino , Refugiados/psicología , Adulto , Persona de Mediana Edad , Ecuador , Migrantes/psicología , Migrantes/estadística & datos numéricos , Adulto Joven , Panamá , Sistemas de Apoyo Psicosocial , Apoyo Social , América LatinaRESUMEN
Refugees and migrants experience an elevated risk for mental health problems and face significant barriers to receiving services. Interpersonal counseling (IPC-3) is a three-session intervention that can be delivered by non-specialists to provide psychological support and facilitate referrals for individuals in need of specialized care. We piloted IPC-3 delivered remotely by eight Venezuelan refugee and migrant women living in Peru. These counselors provided IPC-3 to Venezuelan refugee and migrant clients in Peru (n = 32) who reported psychological distress. Clients completed assessments of mental health symptoms at baseline and one-month post-intervention. A subset of clients (n = 15) and providers (n = 8) completed post-implementation qualitative interviews. Results showed that IPC-3 filled a gap in the system of mental health care for refugees and migrants in Peru. Some adaptations were made to IPC-3 to promote its relevance to the population and context. Non-specialist providers developed the skills and confidence to provide IPC-3 competently. Clients displayed large reductions in symptoms of depression (d = 1.1), anxiety (d = 1.4), post-traumatic stress (d = 1.0), and functional impairment (d = 0.8). Remote delivery of IPC-3 by non-specialists appears to be a feasible, acceptable, and appropriate strategy to address gaps and improve efficiency within the mental health system and warrants testing in a fully powered effectiveness study.
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COVID-19 , Refugiados , Migrantes , Humanos , Femenino , Refugiados/psicología , Proyectos Piloto , Perú/epidemiología , Pandemias , COVID-19/epidemiología , ConsejoRESUMEN
Community-based psychosocial interventions are key elements of mental health and psychosocial support; yet evidence regarding their effectiveness and implementation in humanitarian settings is limited. This study aimed to assess the appropriateness, acceptability, feasibility and safety of conducting a cluster randomized trial evaluating two versions of a group psychosocial intervention. Nine community clusters in Ecuador and Panamá were randomized to receive the standard version of the Entre Nosotras intervention, a community-based group psychosocial intervention co-designed with community members, or an enhanced version of Entre Nosotras that integrated a stress management component. In a sample of 225 refugees, migrants and host community women, we found that both versions were safe, acceptable and appropriate. Training lay facilitators to deliver the intervention was feasible. Challenges included slow recruitment related to delays caused by the COVID-19 pandemic, high attrition due to population mobility and other competing priorities, and mixed psychometric performance of psychosocial outcome measures. Although the intervention appeared promising, a definitive cluster randomized comparative effectiveness trial requires further adaptations to the research protocol. Within this pilot study we identified strategies to overcome these challenges that may inform adaptations. This comparative effectiveness design may be a model for identifying effective components of psychosocial interventions.
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Populations affected by armed conflict and other humanitarian crises are at elevated risk for mental health problems. While the COVID-19 pandemic has had broadly deleterious effects on livelihoods, economic well-being, and population health worldwide, vulnerable groups have been disproportionately impacted by the pandemic. Providing mental health and psychosocial support (MHPSS) services during these times to vulnerable groups, especially in low- and middle-income countries and humanitarian settings, is essential. In an effort to comply with the public health response to the pandemic and mitigate COVID-19 transmission, significant implementation adaptations were made to service delivery during the pandemic. This short report describes several strategies to ensure that equity was central to these adaptations and public health responses, and provides recommendations for ensuring continuity of this progress post-pandemic. Examples and key lessons learned are given related to strategies to increase access to MHPSS services, improve meaningful stakeholder engagement, develop and support community networks, and implement community-based psychosocial support groups. They come from diverse settings of Bangladesh, Colombia, Ecuador, and Lebanon. The COVID-19 pandemic has highlighted the importance of preventing and treating MHPSS issues. It also has created opportunities for innovative programming to address overlooked problems, improve the quality of services provided, and increase focus on equity. It is vital that we use the momentum and attention generated around MHPSS services during the COVID-19 pandemic to continue to build and improve existing MHPSS services in more equitable ways for vulnerable populations.
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BACKGROUND: Community- and strengths-based psychosocial interventions are central to mental health and psychosocial support guidelines, but rigorous evidence regarding the effectiveness of these interventions is limited. The complexity and variability that is inherent to many community-based psychosocial interventions requires innovative strategies in order to facilitate the comparability and synthesis across research studies without compromising the fit and appropriateness of interventions to specific study populations and context. Entre Nosotras is a community-based psychosocial intervention developed for migrant and host community women that is designed to be flexible enough to enable integration of external intervention components and adaptable to diverse study contexts and populations. This protocol describes a study that aims to evaluate the appropriateness, acceptability, and feasibility of integrating a standardized stress management intervention into Entre Nosotras. METHODS: This study will evaluate the appropriateness, acceptability, feasibility, and safety of intervention and research procedures for a cluster randomized comparative effectiveness trial conducted in Ecuador and Panamá with migrant and host community women. In this feasibility trial, we will allocate communities nested within the three study sites to the integrated Entre Nosotras + stress management intervention versus Entre Nosotras alone through stratified randomization. Migrant and host community women residing in these study communities who report low to moderate levels of distress will be allocated to the intervention condition that their community is assigned (n = 220 total). We will collect quantitative measures of psychosocial wellbeing, psychological distress, coping, social support, and functioning from study participants. We will collect quantitative measures of fidelity and facilitator competencies through observation and facilitator self-assessment. Data on appropriateness, acceptability, feasibility, and safety will be gathered from participants and facilitators through quantitative assessments at 0, 5, and 10 weeks post-enrollment and qualitative interviews conducted with all facilitators and a subset of 70 study participants during the post-intervention follow-up period. DISCUSSION: Results from this feasibility trial will determine whether a multi-site cluster randomized comparative effectiveness trial of an adaptable community-based psychosocial intervention for migrant and host community women is relevant, acceptable, and feasible. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT05130944 . Registered November 23, 2021-retrospectively registered.
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There is increasing evidence supporting the effectiveness of scalable mental health and psychosocial support (MHPSS) interventions delivered by non-specialists for improving wellbeing among migrant populations in humanitarian settings. Balancing fidelity in the implementation of evidence-based MHPSS interventions with their fit to the needs and preferences of new populations and contexts remains a challenge when introducing MHPSS interventions in new settings. This paper describes a community-based participatory approach to MHPSS intervention design incorporating processes to promote local adaptability and fit while maintaining standardized elements of existing MHPSS interventions. We conducted a mixed-methods study to design a community-based MHPSS intervention that fit the mental health and psychosocial needs of migrant women in three sites in Ecuador and Panama. Drawing from a set of community-based participatory research methods, we identified the priority mental health and psychosocial needs among migrant women, co-developed intervention mechanisms that aligned with those needs, matched mechanisms to existing psychosocial intervention components, and iteratively piloted and refined the intervention with community stakeholders. The resulting intervention was a five-session, lay facilitator-delivered group intervention titled, Entre Nosotras ('among/between us'). The intervention combined elements of individual and community problem solving, psychoeducation, stress management, and social support mobilization to address prioritized problems including psychological distress, safety, community connectedness, xenophobia and discrimination, and social support. This research outlines an emphasis on the social dimension of psychosocial support, as well as a process for balancing fit and fidelity in intervention design and implementation.
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BACKGROUND: Preventing central line-associated bloodstream infection (CLABSI) and catheter-associated urinary tract infection (CAUTI) remains challenging in intensive care units (ICUs). OBJECTIVE: The Agency for Healthcare Research and Quality Safety Program for ICUs aimed to reduce CLABSI and CAUTI in units with elevated rates. METHODS: Invited hospitals had at least one adult ICU with elevated CLABSI or CAUTI rates, defined by a positive cumulative attributable difference metric (CAD >0) in the Centers for Disease Control and Prevention's Targeted Assessment for Prevention strategy. This externally facilitated programme implemented by a national project team and state hospital associations included on-demand video modules and live webinars reviewing a two-tiered approach for implementing key technical and socioadaptive factors to prevent catheter infections, using principles and tools based on the Comprehensive Unit-based Safety Program. CLABSI, CAUTI and catheter use data were collected (preintervention 13 months, intervention 12 months). Multilevel negative binomial models assessed changes in catheter-associated infection rates and catheter use. RESULTS: Of 366 recruited ICUs from 220 hospitals in 16 states and Puerto Rico for two cohorts, 280 ICUs completed the programme including infection outcome reporting; 274 ICUs had complete outcome data for analyses. Statistically significant reductions in adjusted infection rates were not observed (CLABSI incidence rate ratio (IRR)=0.75, 95% CI 0.52 to 1.08, p=0.13; CAUTI IRR=0.79, 95% CI 0.59 to 1.06, p=0.12). Adjusted central line utilisation (IRR=0.97, 95% CI 0.93 to 1.00, p=0.09) and adjusted urinary catheter utilisation were unchanged (IRR=0.98, 95% CI 0.95 to 1.01, p=0.14). CONCLUSION: This multistate programme targeted ICUs with elevated catheter infection rates, but yielded no statistically significant reduction in CLABSI, CAUTI or catheter utilisation in the first two of six planned cohorts. Improvements in the interventions based on lessons learnt from these initial cohorts are being applied to subsequent cohorts.
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Infecciones Relacionadas con Catéteres/prevención & control , Infección Hospitalaria/prevención & control , Implementación de Plan de Salud , Unidades de Cuidados Intensivos , Desarrollo de Programa , Infecciones Urinarias/prevención & control , Centers for Disease Control and Prevention, U.S. , Estudios de Cohortes , Hospitales Provinciales , Humanos , Incidencia , Puerto Rico , Estados UnidosRESUMEN
OBJECTIVES: To present and discuss recent patterns of prescription opioid sales throughout Brazil. METHODS: We graphed linear trends of opioid prescriptions sold from registered pharmacies across Brazil from 2009 to 2015. We then calculated the change in rate of prescriptions sold per 1000 persons in 2015 compared with 2009. RESULTS: Opioid sales increased across Brazil from 1 601 043 prescriptions in 2009 to 9 045 945 prescriptions in 2015, corresponding to a 465% increase in 6 years. The largest absolute increase was for codeine products (rate ratio (RR) = 5.30; 95% confidence interval [CI] = 5.29, 5.31), accounting for more than 98% of prescriptions in both years. Oxycodone had the largest relative increase (RR = 11.39; 95% CI = 11.19, 11.59), and fentanyl products had the smallest absolute and relative increase (RR = 2.91; 95% CI = 2.78, 3.03). CONCLUSIONS: Given rapid increases in opioid sales across Brazil, it is critical to introduce effective prescribing and monitoring methods that allow patients to access necessary medications without escalating risk of opioid misuse and related consequences. Careful surveillance of supply and subsequent outcomes are needed to prevent the development of another devastating opioid epidemic in the Americas.
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Analgésicos Opioides/uso terapéutico , Prescripciones de Medicamentos/estadística & datos numéricos , Farmacias/estadística & datos numéricos , Brasil/epidemiología , HumanosRESUMEN
Following the 7.8 magnitude earthquake that struck Ecuador on 16 April 2016, multiple salient public health concerns were raised, including the need to provide mental health and psychosocial support for individual survivors and their communities. The World Health Organization and the United Nations High Commissioner for Refugees recommend conducting a desk review to summarize existing information, specific to the affected communities, that will support timely, culturally-attuned assessment and delivery of mental health and psychosocial support shortly after the onset of a disaster or humanitarian emergency. The desk review is one component of a comprehensive toolkit designed to inform and support humanitarian actors and their responders in the field. This commentary provides a case example of the development of a desk review that was used to inform personnel responding to the 2016 earthquake in Ecuador. The desk review process is described in addition to several innovations that were introduced to the process during this iteration. Strengths and limitations are discussed, as well as lessons learned and recommendations for future applications.
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Around the world, populations have experienced shortages of one sex or the other at marriageable ages, as a result of mortality declines. The solutions to this problem vary with the cultural context. Declines in the spousal age difference and increases in dowry payments (India) and polygamy (Africa) are two adjustments to a disequilibrium in the marriage market. We hypothesize that in Brazil the marriage market finds its balance by "recycling" men through highly unstable informal unions. Using census and 1984 survey data, we establish the relationship between a marriage squeeze and the increase in informal marriage. Census data and a competing-risks analysis of marriage choice provide evidence that a marriage squeeze has affected both the chances of marrying at all and the type of marriage entered.
PIP: The competing risks logistic model of the likelihood of entering a formal or informal union or staying single in Brazil reveals that race has a strong effect on marriage choice and marriage, only when region of residence is not included in the model. Blacks are more likely than Whites to enter informal unions. Asians are less likely to enter informal unions. Women in the northeast are less likely to enter formal marriages and more likely to enter informal unions than remaining single. Women in the south are more likely to enter formal marriages. Chances of entering an informal union are increased with urban residence and younger age. Increased schooling decreases the likelihood of entering a formal or informal union. Higher unearned income increases the likelihood of entering an informal union. After age 25 age becomes important in influencing the effects on entering informal and formal unions. Women over the age of 25 years and under the age of 35-39 years are less likely to enter formal unions and more likely to enter informal unions. Women over the age of 35-39 years are less likely to enter informal unions. The proportion of women working decreases the likelihood of formal marriage compared to remaining single and increases the likelihood of consensual unions. A greater supply of men increases the chances of entering a formal marriage rather than remaining single. The supply of men has no effect on remaining single compared to entering an informal union. Census data for 1980 on state level sex ratios and rates of divorced males per ever married women reveal that as the pool of marriageable men declines, it is easier for women to marry, stay married, and to remarry. It is more difficult for men to do so. The interpretation of findings is that Brazil's solution to the marriage squeeze is the recycling of marriage partners and an increase in informal unions. Other non-Latin countries exhibit different responses to the marriage squeeze, such as increased rates of polygyny or reduced spousal age differences.
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Países en Desarrollo , Relaciones Extramatrimoniales , Estado Civil/estadística & datos numéricos , Adolescente , Adulto , Anciano , Brasil , Femenino , Humanos , Masculino , Persona de Mediana Edad , Crecimiento Demográfico , Estudios Retrospectivos , Razón de Masculinidad , Persona Soltera/estadística & datos numéricosRESUMEN
PIP: Census and ethnographic information were used to explain population change between 1970 and 1988 among the Canela population of Ramkokamekra living at Escalvado in northeast Brazil. The first ethnographic evidence was collected by William Crocker in 1957. An official census was conducted in 1970 and was followed by censuses in 1975, 1979, and 1988. The Canela were exposed to white contact in 1750, but their geographic location in the hills made settler contact minimal between 1840 and 1940. In 1963, after attacks on the cattle of the backlanders, the Canela were moved to the Guajajara Indian reservation at Sardinha, and eventually were returned to their homeland. Society was matrilocal and matrilateral; during the study period, mortality declined and the population became younger. Fertility remained stable because extramarital sex declined and an increase in age at marriage offset fertility-enhancing declines in breast feeding. There were improvements in health and nutrition. The crude death rate declined from 53/1000 population for 1970-75 to 29/1000 for 1975-79, and mostly affected mortality among women and children. Age distribution of the population showed changes from a young population to a population with a high proportion of young and old. The dependency ratio between 1970 and 1988 went from .84 to 1.38. A high sex ratio was evidenced, which may have been due in 1988 to the need for old-age pensions. Marriage was matrilocal and endogamous to the tribe. Divorce and separation increased over time, but was still low, particularly for men. Multiple sex partners made certain that women did not remain childless. Adult female status was achieved when childbirth occurred. Young husbands joined their wives in the maternal household, which reduced extramarital relations. When a mother died, the child was secure in having a home with her mother's mother or her mother's sister. The arrival of health services in 1970 and an anthropologist trained nurse led to better treatment for tuberculosis and improvements in health, particularly alcohol misuse. A missionary couple in 1968 added new wells for improved sanitation. The Canela, having been influenced by the backlanders on whom they depended for economic support and by the Indian service, have gradually been moving toward a more rigid and Western definition of sex roles, greater disapproval of homosexuality, and less extramarital sex.^ieng
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Adopción , Distribución por Edad , Antropología Cultural , Censos , Etnicidad , Fertilidad , Indígenas Sudamericanos , Matrimonio , Morbilidad , Mortalidad , Densidad de Población , Ajuste Social , Factores de Edad , Américas , Antropología , Conducta , Brasil , Crianza del Niño , Cultura , Demografía , Países en Desarrollo , Enfermedad , América Latina , Población , Características de la Población , Dinámica Poblacional , Conducta Social , Ciencias Sociales , América del SurRESUMEN
Data are presented for the first country wide prospective study on gastrointestinal tract parasitic infections done in Jamaica. Samples from 2,947 young Jamaicans drawn from all ecological zones and from all parochial divisions of the island were analyzed. Pica was practised by 8.6%. Generally, prevalence of organisms was as follows: Trichuris trichiura (12.3%), Ascaris lumbricoides (9.5%), hookworm (2.2%), Strongyloides stercoralis (0.3%), Giardia lamblia (6.3%) and Entamoeba coli (7.7%). Several other spp. of protozoans were recorded. Prevalence of A. lumbricoides, T. trichiura and Necator americanus was significantly greater in upland than in lowland (both urban and rural), while the situation was reversed for G. lamblia-infections. Greatest variations were age-related. A. lumbricoides and T. trichiura reached peak prevalence of 15.3 and 20.5% respectively in 5-9-year-olds, while hookworm peaked later at 15-19 years of age. Suggestions are made for a national and even regional antihelminthic program for the mass treatment of pre- and primary school age children.
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Parasitosis Intestinales/epidemiología , Adolescente , Animales , Niño , Preescolar , Ecología , Humanos , Lactante , Parasitosis Intestinales/parasitología , Jamaica/epidemiología , Estudios Prospectivos , Salud Rural , Encuestas y Cuestionarios , Salud UrbanaRESUMEN
We identified 59 fetuses and infants with intracranial anomalies over 5 1/2 years. The cases represented heterogeneous diagnostic groups: hydrocephalus with a neural tube defect, hydrocephalus with a specified structural anomaly, hydrocephalus of unspecified or miscellaneous cause, holoprosencephaly, and hydranencephaly. One or more major nonneural tube malformations were present in 19 of 54 cases. Eight of 32 cases had a significant chromosomal abnormality. The rate of survival was poor: 13 of 59 pregnancies were terminated electively before 24 weeks gestation, 10 of 59 infants were stillborn, and 16 of the remaining 38 liveborn infants have died since birth. A prenatal ultrasonographic diagnosis was made in the majority of cases (50 of 59). Diagnostic accuracy of prenatal ultrasound examinations ranged from a high of 90% for hydrocephalus to 33% for holoprosencephaly and hydranencephaly, and a low of 22% for the presence of extracranial malformations. Eleven cases in this series could have been considered potential candidates for in utero treatment of ventriculomegaly; this therapy would have been ineffective or inappropriate in eight of these. We recommend that each case undergo thorough diagnostic evaluation, including ultrasound examination and chromosome studies; that parents be informed of the high frequency of associated anomalies, the poor prognosis regarding survival, and the current limitations of ultrasound diagnostic accuracy; and that in utero treatment of fetal ventriculomegaly seems inadvisable at the present time.
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Ventrículos Cerebrales/anomalías , Hidrocefalia/diagnóstico , Defectos del Tubo Neural/diagnóstico , Diagnóstico Prenatal , Ultrasonografía , Aborto Inducido , Aberraciones Cromosómicas/diagnóstico , Trastornos de los Cromosomas , Cromosomas Humanos 13-15 , Femenino , Muerte Fetal , Humanos , Cariotipificación , Meningomielocele/diagnóstico , Examen Físico , Embarazo , Pronóstico , Tomografía Computarizada por Rayos X , Ultrasonografía/normasRESUMEN
The incidence of Kaposi's sarcoma (KS) was examined with the use of data from the Surveillance, Epidemiology, and End Results (SEER) Program of the National Cancer Institute. KS is a manifestation of the recent epidemic of acquired immunodeficiency syndrome (AIDS) that has occurred particularly among homosexual men. The incidence of KS in 1973-79 was found to be higher (0.29 male and 0.07 female cases/100,000/yr) than is usually cited for the pre-AIDS KS incidence rates. Collectively, the 9 SEER registries in the United States showed only a slight increase in the incidence of KS between 1973-79 and 1980-81. However, the SEER registry covering San Francisco, which is a high-risk area for AIDS, showed a marked excess of KS in 1981. The KS case rate among never-married men younger than 50 years old, a surrogate index of homosexuality, was found to be markedly elevated in the post-AIDS period, compared with the case rate of a reference disease, mycosis fungoides. Never-married men younger than 50 years old, therefore, constitute a SEER-identifiable population who can be monitored for risk of KS and other neoplasms that might be related to AIDS. In addition, the incidence rate of KS in the SEER registry of Puerto Rico was generally higher than that in the U.S. SEER registries, despite data that suggested that KS may be underreported. The demographic characteristics of patients diagnosed as having KS in Puerto Rico suggested the classical rather than the AIDS-related form of KS.
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Micosis Fungoide/epidemiología , Sarcoma de Kaposi/epidemiología , Síndrome de Inmunodeficiencia Adquirida/epidemiología , Factores de Edad , Femenino , Humanos , Masculino , Matrimonio , Persona de Mediana Edad , National Institutes of Health (U.S.) , Puerto Rico , Sistema de Registros , Factores Sexuales , Estados UnidosRESUMEN
Four prepubertal children, all members of melanoma-prone families, developed pigmented scalp lesions that were diagnosed as dysplastic nevi. In three cases, the scalp lesions were the only evidence that the children were affected by the dysplastic nevus syndrome, a distinctive clinicopathologic entity that identifies persons at increased risk of malignant melanoma. In general, the skin of family members with dysplastic nevus syndrome does not show characteristic lesions until just prior to or with the onset of puberty. The presence of dysplastic nevi on the scalp may permit identification of at least some high-risk family members well prior to puberty. This should facilitate the early implementation of a melanoma prevention program for susceptible individuals and help ensure that melanomas are diagnosed early in their natural history, at a time when they are surgically curable.
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Melanoma/genética , Nevo Pigmentado/patología , Lesiones Precancerosas/patología , Cuero Cabelludo/patología , Neoplasias Cutáneas/patología , Niño , Preescolar , Femenino , Humanos , Masculino , Nevo Pigmentado/genética , Linaje , Neoplasias Cutáneas/genéticaRESUMEN
Prospectively collected drug abuse trend surveillance data suggest that the rate of heroin use in Washington, D.C. is rising following a two year decline in the magnitude of this problem. Supportive data include increased potency of street level heroin, increased numbers of heroin-related deaths, increased detection of heroin positive urine specimens in the D.C. Superior Court arrestee population, increased demand for addiction treatment services and rising property crime rates. Increased prevalence of heroin use has not yet been associated with an increase in incidence, suggesting that former heroin users have begun to use once again following a period of abstinence. Analysis of heroin specimens seized across the United States suggests that cities formerly dependant upon European (white) heroin have now developed a new heroin distribution system which supplies Mexican (brown) heroin. This has offset the reduction in heroin use observed during 1972-1973 concomitant with the East Coast heroin shortage and widespread introduction of addiction treatment services.