Medica Research Articles

A posthumous tribute to Alejandro Goic, M.D. (1929-2021), Editor Emeritus

Alejandro Goic, M.D., son of Croatian immigrants, graduated as M.D. in 1955, studying at the Catholic University of Chile Medical School. After a residency in internal medicine, he followed post graduate studies in psychosomatic medicine at the University of Oklahoma and in gastroenterology at Harvard University. Upon his return to Chile he had a brilliant career as clinician and medical educator, becoming a leader and advisor in medical education, clinical ethics and public health. Elected Dean of the University of Chile School of Medicine (1986-1994), he promoted important changes in undergraduate studies as well as in Magister and PhD programs in Biomedical Sciences. During the difficult years of the military government intervention in Chilean universities, he was one of the leaders of critical opposition. In parallel he was chief editor of Revista Médica de Chile (1976-1996), improving the editorial process according to the recommendations of ICMJE and WAME. In 1989 he was elected member of the Chilean Academy of Medicine and became its President (2000-2010). He was awarded honors and membership in prominent national and foreign institutions. In 2006 he received the National Prize in Medicine, the highest medical distinction in Chile. His wise thinking and enthusiasm gave origin to several books that have become classics in Medicine and Medical Education, permeating our institutions.

Informal caregiving and work: A high price to pay. The case of Baltic States

• Informal care obligations deter both extensive and intensive margins of work. • Being a main carer in the household enhances labour market implications. • Caregiving induces excessive utilization of unemployment benefits among males. • Nonemployed males and females respond to care obligations heterogeneously. The impact of informal care burden on the labour market outcomes has been the subject of a number of studies. The literature so far has, however, mostly neglected the post-transition countries. The purpose of this study is to provide empirical evidence on various labour market implications of informal care in the three Baltic States – Estonia, Latvia and Lithuania. In particular, we examine the extensive and intensive margins of work, wage effects, job seeking behaviour and utilization of unemployment benefits. We apply instrumental variable approach to address the observed endogeneity of informal care. The obtained results support the existence of a significant deterrent effect of caregiving on both extensive and intensive margins of work among males and females in all the three countries. Wage penalties are found to be stronger in Estonia and Latvia, where reliance on familial care is particularly high. The evidence also suggests that the existing systems induce excessive utilization of unemployment benefits among males in the three Baltic States. The results provided in this study are germane to the development of national labour market and long-term care policies.

A randomised controlled trial comparing internet-delivered cognitive behavioural therapy (iCBT) with and without main carer access versus treatment-as-usual for depression and anxiety among breast cancer survivors: Study protocol

BackgroundDepression and anxiety are common problems among breast cancer survivors. Carer support is one of the most important determinants of women's psychological wellbeing. Survivors' distress can be alleviated by giving carers access to survivors' evidence-based treatment, which will help carers understand what survivors have been going through and help survivors feel more supported. Given the limited access to evidence-based treatments, an adapted internet-delivered cognitive behavioural therapy (iCBT) intervention for breast cancer survivors, but also open for carers' access, has the potential to decrease survivors' depression and anxiety symptoms and improve cancer-related communication and relationship quality between survivors and carers. ObjectivesThis study evaluates (1) the effectiveness of a guided iCBT intervention for depression and/or anxiety symptoms among breast cancer survivors with and without main carer access, and (2) the acceptability and satisfaction with the iCBT programme. MethodIn this pilot study comparing the effectiveness of an adapted 7-week iCBT without main carer access against the iCBT with main carer access and treatment-as-usual control, 108 breast cancer survivors will be recruited and then randomised to either (1) treatment (n = 72) or (2) treatment-as-usual control group (n = 36) with a 2:1 ratio. The participants in the treatment group will be assigned to either iCBT alone or iCBT with the main carer also having access to the same content based on their preference. The primary outcome measure is the Hospital Anxiety and Depression Scale, and alongside secondary measures such as Cancer-Related Quality of Life, Breast Cancer Worry Scale, Brief COPE, and Medical Outcomes Study Social Support Survey will be completed by the survivors at baseline, post-treatment, and 2-month follow-up. Survivors who have carers will also complete Survivor-Carer Cancer Communication and Relationship Quality measures to provide insights into the effects of carer access. To assess the acceptability and satisfaction with the programme, survivors and their main carers will fill out the Helpful Aspects of Therapy Form (HAT) and Satisfaction with Online Treatment (SAT). Programme effectiveness and the effects of carer access on primary and secondary outcome measures will be evaluated on intention-to-treat and per-protocol basis using Linear-Mixed-Models. DiscussionThis is the first trial comparing the effectiveness and acceptability of iCBT with and without carer access for depression and anxiety among breast cancer survivors. The findings of this study will provide novel data on the acceptability of iCBT programmes for breast cancer survivors and the impact of carer access on them and their carers.

Professor Morteza Samini Retired Editor-in-Chief of Acta Medica Iranica (1945- 2020)

The article's abstract is not available.

The experience of caring for an older relative in Chile: going beyond the burden of care

AbstractCare in Chile, as in most Latin American countries, remains largely the responsibility of female family members in informal arrangements with little government support. The analysis of caring for a dependent older person has commonly been approached from the burden of care perspective, focusing on the tasks carried out, the time spent providing care and the negative (burdensome) consequences for the care-giver. This study reveals the daily experiences of family care-givers of older people through a thematic data analysis of 42 interviews with main family carers of an older person as experienced by the carers themselves. Findings highlight the complex nature of care work. Tasks carried out do not necessarily relate to the intensity of the care experience or a negative experience. Care-givers can work long hours providing care and still feel comfortable and find the experience emotionally rewarding. Care-givers might also carry out only a few tasks and experience pressure. The broader social and economic context can generate constraints that make a specific set of tasks easier or harder on the carer, but these contextual factors do not fully explain the experience of care. Relations, and particularly those that carry an emotional component such as the carer-older person, carer-siblings and carer-spouse, must be considered alongside the tasks and the difficulties or potential constraints of the context to understand the care experience.

Narrative Inquiry On The Experience Of Father Who Took Parental Leave to be the Main Carer

본 연구는 내러티브 탐구를 통해 육아휴직 이후 주 양육자가 된 아버지들의 인생이라는 맥락에서 육아휴직 과정 속에 경험된 것과 이후 주 양육자로의 지속된 삶이 가지는 의미를 이야기하고자 하였다. 이를 위해 육아휴직을 한 경험을 아버지가 어떻게 주 양육자로 양육을 지속하고 있는지 삶의 시간성을 고려하여 탐구하고자 하였다. 육아휴직 이후 주 양육자로 살아가고 있는 아버지 3명과의 심층면담자료를 최종연구 텍스트로 활용하였으며, 이를 바탕으로 육아휴직 이후 주 양육자로 살아가는 경험의 의미를 도출하였다. 경험의 의미는 <강에서 바다로 나아가다>, <폭포를 뛰어넘다>, <거슬러 올라 만난 강>, <다시 바다로>로 구성되었다. 본 연구는 육아휴직 이후 주 양육자가 된 아버지의 삶의 이야기를 통해 육아휴직과 이후 양육 경험에 대해 심층적으로 알아보며, 가정이라는 공간 안에서 경험하게 되는 아버지의 양육은 어떠한 특징을 가지는지 살피는 데 의의가 있다. 이는 육아휴직이라는 특수한 환경에서 일어나는 개인적, 관계적, 사회적 변화를 시간의 흐름에 따라 탐색함으로써 아버지 내면에 일어날 수 있는 어려움과 더불어 양육을 공동으로 담당함으로써 발생하는 부부갈등에 대한 심리 사회적 개입에 대한 기초자료를 제공하였다는 점에서 의의가 있다. 마지막으로 본 연구의 제한점과 후속연구를 위한 제언을 담았다.In this narrative exploration, the purpose of this study was to describe the meaning of the experiences of parental leave in the context of life as a father after taking parental leave, and the meaning of life afterwards as a main carer for his child. To this end, the researcher explored how the father continued his life as a main carer, after taking parental leave, taking into account of the temporality of life. In-depth interview data was collected with three fathers who have been living as main carer after parental leave and the data was used for the final study. Based on this, the meaning was derived from the experience of living as a main carer after parental leave. The meaning of the experience consisted of <Going from the river to the sea>, <Jumping over the waterfall>, <Go up the river>, and <Back to the sea>. This study explores parenting leave and parenting experiences in details, through the story of the father’s life, who became the main carer after parental leave, and it is meaningful as it examined the characteristics of father’s parenting experienced in the space of home. This is meaningful as it provided the basis for psychological interventions in marital conflict over joint responsibility for parenting as well as inner conflicts of fathers in exploring personal, relational, and social changes in the special environment of parental leave over time. Lastly, the study defined limitations of this study and made suggestions for follow-up studies.

Structuring unequal relations: role trajectories in informal dementia care

Transitions into informal care roles are associated with various characteristics, for example gender and geographic proximity, but such associations are insufficient to explain role delegation, overlooking the interpersonal structure-agency nexuses that constitute role trajectories. This paper explores unequal role delegation within 7 families affected by dementia, presenting data from interviews with 7 people with dementia and 26 carers living in the community in the United Kingdom. Two key care roles are identified: the relatively un-involved role of peripheral actors and the lynchpin role of main carers who take on most of the care tasks. These roles emerge from negotiations around a range of extraneous factors that collectively comprise cumulative baggage, including historic conflicts and childcare commitments. The unequal distribution of care reflects widely noted demographic associations with role delegation, but is enacted and justified through the interpersonal negotiation of personalised meanings regarding individual circumstances and suitability. Though deeply personal when taken at face value, these meanings imbibe sociocultural norms and political economies of care to structurally position family members in relation to each other and signpost appropriate candidates for caring roles, even before such care is required.

Dementia services for people from Black, Asian and Minority Ethnic and White-British communities: Does a primary care based model contribute to equality in service provision?

This study set out to investigate whether there were disparities in service provision for people from Black, Asian and Minority Ethnic (BAME) communities compared to White British (WB) communities within a primary care led dementia service in the UK. Data were extracted from 30 cases from three BAME (African-Caribbean, South Asian and Chinese) communities who had been referred to a dementia service between April 2016 and December 2017. We then extracted data from 30 WB cases matched for gender, age (within 5years) and General Practitioner surgery. We compared service provision for both samples around assessment, diagnosis and post-diagnostic support. The primary source of information in the BAME sample was less likely to be recorded as being the main carer and more likely to be an adult child. Cases from both samples were equally likely to have a CT scan. People from BAME communities were less likely to receive a cognitive assessment, and when they did they scored at a lower level. There was no difference between samples for the diagnoses that cases received, but BAME cases were more likely to be assessed as being low rather than medium or high risk. While cases from both samples were equally likely to receive medication, BAME cases were more likely to be seen by a psychiatrist. Significantly more people from the WB sample were recorded as using or being offered more than one form of community support. This study of a primary care-based dementia service suggests that while many areas of service provision showed no evidence of inequality, important differences remain including the time at which people present for assessment and the range of post-diagnostic services which are discussed. Further research is required to establish the likely causes of these disparities.

Attitudes and beliefs of parents of children with disabilities in Uganda

Background. Little is known about the experience of carers of children with disabilities in Uganda, where child disability constitutes 31.4% of all disabilities. This study examined the experiences, beliefs, and attitudes of parents/ main carers of children with disabilities, and the challenges they face, in order to optimize rehabilitation strategies for the child and their family. Methods. Qualitative data were collected from ten semi - structured interviews with eight main carers children receiving rehabilitation in rural Uganda. Results. Three main themes were identified: (1) experiences, (2) beliefs, and (3) attitudes of the parents/ main carers. Carers experienced emotional stress and many life changes as the burden of care fell primarily on them. A lack of knowledge and information about disability amongst carers, resulted in alternative beliefs about treatment. Social stigma towards disability remains an issue within Ugandan society. Conclusions. Family centered rehabilitation should be incorporated into rehabilitation programmes to decrease burden of care upon the main carer. Health care practitioners are in a strong position to educate families about causation, diagnosis, and prognosis of a child’s condition, but such services should be improved through community education about disability and facilitated with the development of parental support groups.

FAB: First UK feasibility trial of a future randomised controlled trial of Family focused treatment for Adolescents with Bipolar disorder

BackgroundThis first mixed-methods UK trial examined the feasibility and acceptability of a future definitive randomised controlled trial (RCT) to evaluate whether Family Focussed Treatment for Adolescents with Bipolar Disorder (FFT-A) UK version can improve family functioning and well-being as part of the management of Paediatric Bipolar Disorder (PBD).MethodThe trial used a randomised, parallel group, non-blinded design where participants received FFT-A UK (16 sessions over 6 months) immediately or after 12 months (delayed arm). Measures of family functioning, well-being and quality of life of the young person and the main carer (most commonly a parent) were completed at baseline, 6 and 12-months in both arms. Primary outcome measures included rates of eligibility, consent and retention along with estimates of variability in the measures and assessment of the intervention delivery. Qualitative interviews allowed assessment of participants’ views about FFT-A and the trial processes.ResultsTwenty-seven of 36 young persons with PBD and their families consented; of these, 14 families were randomised to the immediate and 13 to the delayed arm. Two families from the immediate arm withdrew consent and discontinued participation. Quantitative measures were completed by 22 families (88%) at 6-months and 21 families (84%) at 12-months. Qualitative interviews were conducted with 30 participants (9 young people, 15 parents and 6 other family members). Nine families attended 3 post-trial focus groups.ConclusionIt was feasible to recruit and retain to this trial. The results highlighted that trial design and measures were acceptable to participants. A benefit in family relationships was reported by participants which they attributed to the intervention in qualitative interviews. Families recommended that future modifications include definitive trial(s) recruiting participants in the age range 15–25 years as it felt this was the age range with maximum need.Trial registration ISRCTN, ISRCTN59769322. Registered 20 January 2014, http://www.isrctn.com/ISRCTN59769322

Pediatric residency program accreditation process by the Council for the Accreditation of Education Institutions

Postgraduate medical education as part of a residency system is the best model for specialist training. The accreditation of residency programs entails a harmonization and standardization process. It defines a common and reproducible basis to ensure high-quality training and universal curricular guidelines. To describe the pediatric residency program accreditation process by the Council for the Accreditation of Education Institutions between January 2011 and July 2017. The accreditation process was developed according to a reference framework that defined 6 domains and 28 items. Based on compliance, 3 accreditation categories were established. The analysis of accredited residency programs was categorized into 3 geographic regions: province of Buenos Aires, Autonomous City of Buenos Aires (CABA), and other regions. Each analyzed item was dichotomized into noncompliance and partial or total compliance. Categorical outcome measures were expressed in absolute numbers and percentage. Ninety-four pediatric residency programs were assessed: 34 (36%) corresponded to the province of Buenos Aires; 25 (27 %), to CABA; and 35 (37 %), to other regions. In total, 79 (85 %) were in the public sector. The maximum accreditation category was achieved by 35 (37 %). Four (4 %) were not accredited. Compliance for most items corresponding to the 6 domains was over 80 %. Most assessed residency programs were accredited and complied with the reference standards. Introducción. La formación médica de posgrado en un sistema de residencias constituye el mejor modelo para la formación de especialistas. La acreditación de residencias implica un proceso de armonización y normalización de criterios. Establece una base común y reproducible, que asegura una formación de calidad y con lineamientos curriculares universales.

Arkansas DHS mental health provider pleads guilty to obstruction

The owner and CEO of Little Rock‐based New Beginnings Behavioral Health Services has pleaded guilty to obstructing governmental operations, Arkansas Attorney General Leslie Rutledge's office announced July 14, Talk, Business and Politics reported. Rutledge's office said Chirie Bazzelle, 46, of Benton, did not report contracts with lobbyist Rusty Cranford and Robin Raveendran, a former Department of Human Services (DHS) auditor. The office said those two and other full‐time employees of Preferred Family Healthcare, a community‐based health care organization, helped make New Beginnings one of the state's largest single‐site mental health providers. New Beginnings billed the state Medicaid program more than $5.3 million in 2018, but because of Bazelle's arrest and the investigation, it is no longer a Medicaid provider. The release said Bazzelle also concealed the employment of at least one person who had been convicted of Medicaid fraud. “This culture of corruption (is) rampant through our Medicaid system, and it must be stopped,” Rutledge said in a press release. “Bazzelle is another bad actor who should never be allowed to work in our healthcare system, and people like her must be removed from their positions.” New Beginnings has been in business since 2009. Its psychotherapists provide counseling and treatment to children and adults with problems related to trauma, anger management, and other issues.

Análisis de citas de cuatro revistas biomédicas latinoamericanas

Las revistas Archivos de Investigación Médica (México), Medicina (Argentina), Revista do Instituto de Medicina Tropical de Sao Paulo (Brasil), y Revista Médica de Chile (Chile) fueron seleccionadas con el fin de hacer un análisis de citas, conocer sus patrones de intercomunicación, y detectar indicadores importantes para continuar investigaciones afines . La selección de las revistas se realizó a través de un análisis de las publicaciones de mayor difusión en seis índices secundarios internacionales (Index Medicus, lndex Medicus Latinoamericano , Excerpta Medica, Science Citation lndex, Biological Ahstracts, y C'hemical Abstracts). Science Citation, lndex Journal Citation Reports 1987, se utilizó como fuente para realizar el análisis de citas, conocer los factores de impacto y los diferentes indices de las revistas mencionadas. Los resultados indican que Medicina (Argentina) es la revista superior en factor de impacto, citas recibidas y rango en su categoría temática. Archivos de lnvestigación Médica (México) por otro lado, es citada por revistas de alto impacto internacional, y cuenta con una vida media de citaciones superior a los diéz años. En general. los resultados obtenidos no concluyen sobre patrones regionales o temáticos significativos: sin embargo, sí ayudan a establecer las bases de investigación específicas a seguir. Dichas líneas de investigación son descritas por el autor.

Recommendations to protect patients and health care practices from Medicare and Medicaid fraud

Fraud is defined as knowingly submitting, or causing to be submitted, false claims or making misrepresentations of a fact to obtain a federal health care payment for which no entitlement would otherwise exist. In today’s health care environment, Medicare and Medicaid fraud is not uncommon. The negative impact of fraud is vast because it diverts resources meant to care for patients in need to the benefit of fraudsters. Fraud increases the overall costs for vital health care services and can potentially be harmful to Medicare and Medicaid beneficiaries. The objectives of this commentary are to describe the types and trends of Medicare and Medicaid fraud that are committed, and provide recommendations to protect patients and health care practices. Specifically, this article identifies types of Medicare and Medicaid fraud at beneficiary (patient) and provider level, and it can be intentional or unintentional. This article also describes the 3 primary laws that prohibit fraud and gives fraud case examples relevant to each law, including the False Claims Act, Anti-Kickback Statute, and the Stark Law. We also discuss currently trending and emerging areas, including opioid and pharmacogenetic testing; both have experienced heavier and higher-profile instances of fraud in today’s health care landscape. Last, the article summarizes detection methods and recommendations for health care providers and patients to protect themselves against fraud. Recommended strategies to combat fraud are discussed at policy, practice, and grassroots levels. Health care practitioners, including pharmacists, can use these strategies to protect themselves and their patients from becoming victims of fraud or unknowingly committing fraud.

Effect of Echinacea pallida supplementation on the amino acid and fatty acid composition of Pharaoh Quail meat

The purpose of the research was to investigate the effect of Echinacea pallida extract effect on the amino acid and fatty acid content of Pharaoh Quail meat. We proved that the amount of essential amino acids was greater by 1.31% in the pectoral muscles of Quails that consumed 12 mg/kg of Ehinacea pallida dry extract. This increase was caused by the better accumulation of lysine, arginine, threonine, leucine, and phenylalanine. The amount of essential amino acids was the highest in the thigh muscles of the control group. We found that the quality of fatty acid composition of the pectoral muscles was better due to the greater accumulation of linoleic, γ-linolenic, and α-linolenic acids. The accumulation rate of linoleic, γ-linolenic, and arachidonic fatty acids was higher in thigh muscles of the experimental Quail. Keywords: Quails; Phytobiotics; Echinacea pallida; Amino acids; Meat; Fat acids References Allen, P. (2003). 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Long-Term Efficacy of the Workshop Vs. Online SUCCEAT (Supporting Carers of Children and Adolescents with Eating Disorders) Intervention for Parents: A Quasi-Randomised Feasibility Trial.

Interventions for main carers of adult patients with anorexia nervosa (AN) can reduce the caregiving burden and increase caregiver skills. However, the effectiveness and feasibility for carers of adolescent patients, the optimal form of the intervention and long-term outcomes are largely unknown. We evaluated the efficacy and feasibility of the “Supporting Carers of Children and Adolescents with Eating Disorders in Austria” (SUCCEAT) workshop vs. online intervention. Main caregivers (parents) of adolescent patients with AN were randomly allocated to a workshop (n = 50) or online version (n = 50). Participants were compared to a non-randomised comparison group (n = 49) receiving multi-family or systemic family therapy. Primary (General Health Questionnaire) and secondary outcomes were obtained at baseline, three-month and 12-month follow-up. Adherence was high for workshop and online participants (6.2 and 6.7 sessions completed out of 8). Intention-to-treat analyses revealed significant pre–post reductions in the primary outcome for the workshop (d = 0.87 (95%conficence interval (CI): 0.48; 1.26)) and online (d = 0.65 (95%CI: 0.31; 0.98)) intervention that were sustained at the 12-month follow-up. There was no significant group difference (p = 0.473). Parental psychopathology and burden decreased and caregiver skills increased in all groups; the improvement of caregiver skills was significantly higher in SUCCEAT participants than in the comparison group. Online interventions for parents of adolescents with AN were equally effective as workshops. The improvements remained stable over time.

Competências do enfermeiro em emergência e o produto do cuidar em enfermagem: revisão integrativa

Objetivo: identificar as competências do enfermeiro em emergência e o produto do cuidar em enfermagem. Métodos: revisão integrativa com 16 estudos incluídos, identificados por meio de busca eletrônica na Literatura Latino-Americana e do Caribe em Ciências da Saúde, Sistema Online de Busca e Análise de Literatura Médica, Cumulative Index to Nursing and Allied Health Literature e Scientific Eletronic Library Online a partir de descritores: Professional Competence, Emergency Nursing, Nursing Assessment, Process Assessment (Health Care), Nursing Service, Hospital, Nursing Care e Professional Practice. Resultados: foram incluídos 16 estudos, dos quais 12 apresentaram as competências mínimas requeridas ao enfermeiro de emergência, e 4 se referiam ao produto do cuidar em enfermagem. Conclusão: as competências que mais emergiram foram “desempenho assistencial” e “liderança”. O produto do cuidado em enfermagem precisa ser mais explorado, sobretudo nas emergências.

Basic study on treatment of COVID-19 with Shufeng Jiedu Capsule and research and development ideas of new Chinese materia medica against COVID-19

Basic study on treatment of COVID-19 with Shufeng Jiedu Capsule and research and development ideas of new Chinese materia medica against COVID-19

Eficiencia y efectividad del servicio de catálogo colectivo de publicaciones seriadas

Se realiza un estudio de la eficiencia y efectividad del servicio de catálogo colectivo de publicaciones seriadas del Sistema Nacional de Información de Ciencias Médicas de Cuba, en el que se consideran los indicadores costo-tiempo-productividad para medir la eficiencia. La efectividad se evalúa mediante el análisis de la necesidad . Los resultados obtenidos muestran valores positivos en cuanto a la eficiencia, aunque en relación con la efectividad no son tan satisfactorios. Se ofrecen los resultados en forma de números absolutos y en valores porcentuales, que se representan en gráficos estadísticos y tablas.

Investigation of potential Chinese materia medica and its monomers in treatment of coronavirus disease 2019 (COVID-19) based on angiotensin converting enzyme II (ACE2) receptor

Investigation of potential Chinese materia medica and its monomers in treatment of coronavirus disease 2019 (COVID-19) based on angiotensin converting enzyme II (ACE2) receptor