RESUMO
INTRODUCTION: Studies have shown mixed findings regarding the impact of immigration policy changes on immigrants' utilization of primary care. METHODS: We used a difference-in-differences analysis to compare changes in missed primary care appointments over time across two groups: patients who received care in Spanish, Portuguese, or Haitian Creole, and non-Hispanic, white patients who received care in English. RESULTS: After adjustment for age, sex, race, insurance, hospital system, and presence of chronic conditions, immigration policy changes were associated with an absolute increase in the missed appointment prevalence of 0.74 percentage points (95% confidence interval: 0.34, 1.15) among Spanish, Portuguese and Haitian-Creole speakers. We estimated that missed appointments due to immigration policy changes resulted in lost revenue of over $185,000. CONCLUSIONS: We conclude that immigration policy changes were associated with a significant increase in missed appointments among patients who receive medical care in languages other than English.
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Emigração e Imigração , Provedores de Redes de Segurança , Agendamento de Consultas , Haiti , Humanos , Massachusetts , Políticas , Estados UnidosRESUMO
Abstract It was in the 1980s that a new field in historical studies began to emerge, the animal history, or more specifically the history of human-animal relations. Harriet Ritvo - an eminent American historian and Emeritus Professor at Massachusetts Institute of Technology - is a pioneer in this field. Her career has been dedicated, among other activities, to researching, writing, teaching and lecturing on the subject. In this interview, Professor Ritvo talks about aspects of her academic trajectory, as well as important features of animal history, such as interactions between this area and other fields in which she also works: environmental history, the history of science and the history of technology.
Resumo Na década de 1980 começou a surgir um novo campo nos estudos históricos, a história dos animais, ou, mais especificamente, a história das relações entre os seres humanos e os animais. Harriet Ritvo - eminente historiadora norte-americana e professora emérita do Massachusetts Institute of Technology - é pioneira nessa área. Sua carreira tem sido dedicada à pesquisa, à escrita, ao ensino e à apresentação de palestras sobre o assunto. Nesta entrevista, Ritvo fala sobre aspectos de sua trajetória acadêmica e também sobre importantes questões da história dos animais, tais como as interações dessa área com outros campos nos quais ela também atua: história ambiental, história da ciência e história da tecnologia.
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Estudos Interdisciplinares , Interação Humano-Animal , Animais , Tecnologia , História do Século XX , Meio AmbienteRESUMO
Objectives: In clinical trials of pediatric trichotillomania (TTM), three instruments are typically employed to rate TTM severity: (1) the Massachusetts General Hospital Hair Pulling Scale (MGH-HPS), (2) the National Institute of Mental Health Trichotillomania Severity Scale (NIMH-TSS), and (3) the Trichotillomania Scale for Children (TSC). These instruments lack standardized definitions of treatment response, which lead researchers to determine their own definitions of response post hoc and potentially inflate results. We performed a meta-analysis to provide empirically determined accuracy measures for percentage reduction cut points in these three instruments. Methods: MEDLINE was searched for TTM clinical trials. A total of 67 studies were initially identified, but only 5 were clinical trials focused on TTM in pediatric populations and therefore were included in this meta-analysis (n = 180). A Clinical Global Impressions Improvement score ≤2 was used to define clinical response. Receiver operating characteristic principles were employed to determine accuracy measures for percentage reduction cut points on each one of the instruments. Meta-DiSc software was employed to provide pooled accuracy measures for each cut point for each instrument. The Youden Index and the distance to corner methods were used to determine the optimal cut point. Results: The optimal cut points to determine treatment response were a 45% reduction on the MGH-HPS (Youden Index 0.40, distance to corner 0.20), a 35% reduction on the NIMH-TSS (Youden Index 0.42, distance to corner 0.17), a 25% reduction on the TSC child version (TSC-C; Youden Index 0.40, distance to corner 0.18), and a 45% (distance to corner 0.30) or 50% reduction (Youden Index 0.33) on the TSC parent version (TSC-P). The TSC-C had less discriminative ability at determining response in younger children in comparison to older children; no age-related differences were observed on the TSC-P. Conclusions: This study provides empirically determined cut points of treatment response on three instruments that rate TTM severity. These data-driven cut points will benefit future research on pediatric TTM.
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Tricotilomania/terapia , Adolescente , Fatores Etários , Criança , Humanos , Índice de Gravidade de Doença , Resultado do Tratamento , Tricotilomania/fisiopatologiaRESUMO
A method based on Melting Temperature analysis of Hypervariable regions (HVR) of S1 gene within a RT-qPCR was developed to detect different genotypes of avian infectious bronchitis virus (IBV) and identify the Mass genotype. The method was able to rapidly identify the Mass genotype among IBV field isolates, vaccine attenuated strains and reference M41 strain in allantoic liquid and also directly in tissues. The RT-qPCR developed detected the virus in both tracheal and pulmonary samples from M41-infected or H120-infected birds, in a larger post-infection period compared to detection by standard method of virus isolation. RT-qPCR method tested provided a sensitivity and rapid approach for screening on IBV detection and Mass genotyping from IBV isolates.
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Infecções por Coronavirus/veterinária , Vírus da Bronquite Infecciosa/genética , Doenças das Aves Domésticas/diagnóstico , Reação em Cadeia da Polimerase em Tempo Real/veterinária , Animais , Benzotiazóis , Galinhas/virologia , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/virologia , Diaminas , Genótipo , Pulmão/virologia , Desnaturação de Ácido Nucleico , Compostos Orgânicos/uso terapêutico , Doenças das Aves Domésticas/virologia , Quinolinas , Traqueia/virologiaAssuntos
Centros Médicos Acadêmicos/tendências , Anestesia/tendências , Prova Pericial/tendências , Hospitais com Alto Volume de Atendimentos/tendências , Substituição da Valva Aórtica Transcateter/tendências , Centros Médicos Acadêmicos/métodos , Anestesia/métodos , Anestésicos/administração & dosagem , Europa (Continente)/epidemiologia , Prova Pericial/métodos , Humanos , Salas Cirúrgicas/métodos , Salas Cirúrgicas/tendências , Substituição da Valva Aórtica Transcateter/métodos , Estados Unidos/epidemiologiaRESUMO
Sexual dysfunctions are a highly prevalent problem. It is necessary to have instruments adapted to the Colombian population in order to evaluate their sexual functioning because to date none of them have been validated. The aim of this study was to adapt and validate the Massachusetts General Hospital-Sexual Functioning Questionnaire in Colombian population, and compare it with a similar sample from Spain. Two different samples were used in this study. On one hand, a sample of expert judges who performed the cultural adaptation and the evaluation of the scale, and on the other hand, a second end sample of 1117 participants -men and women of both nationalities- who answered the questionnaire -together with others-through a virtual platform. Some of the items were adjusted based on the initial results of the evaluation by the expert judges. Cronbach's alpha between .81 and .92 were obtained after the application of the test. The psychometric properties of the scale are adequate and this instrument properly correlates with other criterion variables. Construct validity was evaluated using factorial invariance. The unidimensional configural model for men (RMSEA= .000; CFI = 1) and for women (RMSEA= .048, CFI = .997) had an adequate fit, and a level of strict invariance was also reached. Screening can be performed with this first validated scale in order to evaluate the sexual difficulties of the Colombian population and compare them with the Spanish population.
Las disfunciones sexuales son un problema muy frecuente. Es necesario contar con instrumentos adaptados a la población colombiana con el fin de evaluar su funcionamiento sexual porque hasta la fecha ninguno de ellos se ha validado. El objetivo de este estudio fue adaptar y validar el Cuestionario de funcionamiento sexual del Hospital General de Massachusetts en la población colombiana y compararla con una muestra similar de España. Se utilizaron dos muestras diferentes en este estudio. Por una parte, una muestra de jueces expertos que realizaron la adaptación cultural y la evaluación de la escala, y por la otra, una segunda muestra final de 1.117 participantes - hombres y mujeres de ambas nacionalidades - que respondieron el cuestionario, junto con otros, a través de una plataforma virtual. Algunos de los elementos se ajustaron según los resultados iniciales de la evaluación realizada por jueces expertos. Se obtuvieron coeficientes alfa de Cronbach entre 0.81 y 0.92 después de la aplicación de la prueba. Las propiedades psicométricas de la escala son adecuadas y este instrumento se correlaciona debidamente con otras variables para el criterio. La validez del constructo se evaluó mediante invariancia factorial. El modelo configural unidimensional para los hombres (RMSEA = 0.000; CFI = 1) y para las mujeres (RMSEA = 0.048; CFI =0.997) tenía un ajuste adecuado, y también se alcanzó un nivel de estricta invariancia. Puede realizarse un cribado con esta primera escala validada para evaluar las dificultades sexuales de la población colombiana y compararlas con las de la población española.
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Humanos , Masculino , Feminino , Adulto , Idoso , Inquéritos e Questionários , Análise Fatorial , Estudo de Validação , Saúde SexualRESUMO
OBJECTIVE: To review symptoms and provider history in a large cohort of patients with germ cell tumors (GCTs) to highlight the variety of manifestations and assess the effect of delayed diagnosis on outcomes. STUDY DESIGN: Patients treated for intracranial pure germinoma and nongerminomatous GCTs at Massachusetts General Hospital between 1998 and 2012 were included (n = 70). The primary outcome was time from onset of symptoms to diagnostic imaging. Delay was defined as an interval of ≥ 6 months. RESULTS: The median duration of symptoms before diagnostic magnetic resonance imaging was 6 months (range, 2 days to 72 months). Thirty-eight of the 70 patients (54%) had a delayed diagnosis. Patients with suprasellar tumors presented with symptoms related to endocrinopathies, and patients with pineal region tumors presented with symptoms related to hydrocephalus. Most of the patients were evaluated by a general pediatrician (49%) and/or pediatric subspecialists (66%) before diagnosis. Patients with delayed diagnosis saw a greater number of physicians before diagnosis (P = .006). The majority of patients (63%) with delayed diagnosis were seen by 2 or more physicians, and many (40%) were seen by 2 or more subspecialists. Progression-free survival was similar in the patients with delayed diagnosis and those without delayed diagnosis (P = .90), but the former were more likely to present with disseminated disease at diagnosis (34% vs 6%; P = .007). CONCLUSION: A significant proportion of patients with GCT experience a delay in time to diagnosis, in some cases despite evaluation by general pediatricians and specialists. This delay increases the risk of disseminated disease.
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Diagnóstico Tardio , Germinoma/diagnóstico , Neoplasias Embrionárias de Células Germinativas/diagnóstico , Adolescente , Criança , Pré-Escolar , Estudos de Coortes , Intervalo Livre de Doença , Feminino , Humanos , Lactente , Imageamento por Ressonância Magnética , Masculino , Pediatria , Risco , Fatores de Tempo , Resultado do TratamentoRESUMO
El profesor Raymond D. Adams (1911-2010) fue una de las figuras más prominentes de la neurología norteamericana en el siglo XX. Realizó sus estudios de medicina en la Universidad de Duke. Posteriormente, inició especialización en psiquiatría, pero optó por dedicarse al estudio de la patología del sistema nervioso y a la neurología en el Hospital de Boston durante 10 años. Luego fue contratado por el Hospital General de Massachusetts, donde dirigió del Departamento de Neurología por más de 25 años. Fue profesor emérito de neuropatología de la Universidad de Harvard y obtuvo distinciones de otras universidades y sociedades científicas en los Estados Unidos y en otros países. Contribuyó de manera decisiva a la consolidación de la neurología en Norteamérica creando una escuela de fama mundial. Describió varios síndromes, aportó al desarrollo de otras ramas de la neurociencia, publicó múltiples artículos científicos y, desde 1977, junto con el Dr. Maurice Victor, el libro Principios de neurología, que se ha convertido en un clásico en la materia, traducido a varios idiomas. Dirigió un Departamento en donde se ha formado un muy destacado grupo de neurólogos de varias nacionalidades que dan brillo a la neurología mundial.
Professor Raymond D. Adams (1911-2010) has been one of the most prominent figures in North American neurology in the XX century. He studied medicine at Duke University. He began training in psychiatry but decided to study nervous system pathology and neurology in Boston City Hospital during ten years. Then he became chairman of the neurology department in Massachusetts General Hospital for more than twenty five years. He was Neuropathology Emeritus Professor at Harvard University and has been recognized by other universities and scientific associations in United States and in other countries. His contribution to North American Neurology consolidation has been crucial. He described various syndromes and contributed to the development of other fields in neuroscience. He wrote and published many scientific articles and since 1977 with his colleague Maurice Victor the books "Principles of Neurology" a classic in the field, being traduced to many languages. He has been the chairman of a Department where many important neurologists from different parts of the world where trained and brighten neurology worldwide.
O professor Raymond D. Adams (1911-2010) foi uma das figuras mais proeminentes da neurologia norte-americana no século XX. Realizou seus estudos de medicina na Universidade de Duke. Posteriormente iniciou especialização em psiquiatria, mas optou por dedicar-se ao estudo da patologia do sistema nervoso e à neurologia no Hospital de Boston durante dez anos. Depois foi contratado pelo Hospital Geral de Massachusetts onde dirigiu o departamento de neurologia por mais de 25 anos. Foi professor emérito de Neuropatologia da Universidade de Harvard e obteve distinções de outras universidades e sociedades científicas nos Estados Unidos e em outros países do mundo. Contribuiu de maneira decisiva à consolidação da neurologia em Norte-América criando uma escola de fama mundial. Descreveu várias síndromes, contribuiu o desenvolvimento de outros ramos da neurociência, publicou múltiplos artigos científicos e desde 1977 junto com o Dr. Maurice Victor, o livro "Princípios de Neurologia" que tem se convertido em um clássico na matéria, traduzido a vários idiomas. Dirigiu um Departamento onde tem se formado em um muito destacado grupo de neurologistas de várias nacionalidades que dão brilho à neurologia mundial.
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Humanos , Biografia , Docentes , Neurologistas , História da MedicinaRESUMO
"AIDS Awareness Is Love Awareness." It's a message Massachusetts health officials and AIDS educators hope will reach the state's Black male community, a group that is seeing its rate of HIV infection rise at alarming rates. The campaign is aimed exclusively at Black men, and health officials say it comes none too soon. Black men make up only 2.2% of the state's population, yet comprise 19% of all male cases of AIDS in Massachusetts according to the state's Department of Public Health (DPH). More than 1700 Black males in Massachusetts have been diagnosed with AIDS. Nationwide, AIDS is the leading cause of death among Black males aged 25-44. As the director of an AIDS prevention clinic, Lawrence Robinson knows how difficult it is to teach young people, especially young Black males, about the dangers of unprotected sex. Once Robinson was preaching his message to a teenager on the streets of Boston. "What he said to me was, 'What do I have to look forward to? I'm having sex, I like it, and I'm not going to let anybody take that away from me,'" Robinson said.
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Síndrome da Imunodeficiência Adquirida , Atitude , Negro ou Afro-Americano , Preservativos , Educação em Saúde , América , Comportamento , Anticoncepção , Cultura , Demografia , Países Desenvolvidos , Doença , Educação , Etnicidade , Infecções por HIV , Massachusetts , América do Norte , População , Características da População , Psicologia , Estados Unidos , VirosesRESUMO
"Based on ethnohistorical research (1910-1990) conducted in New Bedford, an industrial town of New England, U.S.A., this paper is directed at unveiling an apparent paradox: on the one hand, the analysis of domestic structures indicated that there has been since the late 1970's both an intensification of old and the emergence of new forms of transnationalism among [New Bedford's] Portuguese families; and, on the other hand, the observation of grass-roots 'community events' sugggested a simultaneous and progressive increase of ethnic insularity." (SUMMARY IN ENG)