Publications by authors named "Sergio Castro"

50 Publications

Feasibility and Acceptability of Comprehensive Virtual Treatment in Eating Disorders: Perspectives from Patients, Parents and Therapists During the COVID-19 Pandemic.

Rev Colomb Psiquiatr 2021 Sep 4. Epub 2021 Sep 4.

Programa Equilibrio para trastornos alimentarios, afectivos y de ansiedad, Bogotá, Colombia.

Background: Lockdowns and social distancing as a result of the COVID-19 pandemic have brought about the need to continue treatment virtually in patients with Eating Disorders (ED).

Objective: To evaluate feasibility, acceptability and adherence to virtual treatment in patients, families and therapists.

Methods: Fourteen patients, 10 family members and eight therapists from an intensive outpatient program for ED answered online surveys and a SWOT analysis was performed with the responses.

Results: Virtual treatment during lockdown was considered feasible and useful by all respondents. Fear of contagion and the presence of parents in the home were identified as strengths. Parents reported problems with nutritional plan compliance, especially in anorexia patients. Therapists highlighted the importance of methodological adaptations in sessions to improve participation. Adherence to sessions was 100% for family members and 90% for patients.

Conclusions: Adaptation to a virtual program is a valid and useful option during lockdowns. It improves family participation, but does not replace face-to-face treatment.
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http://dx.doi.org/10.1016/j.rcp.2021.07.011DOI Listing
September 2021

Access barriers, self-recognition, and recognition of depression and unhealthy alcohol use: A qualitative study.

Rev Colomb Psiquiatr (Engl Ed) 2021 Jul 8;50 Suppl 1:52-63. Epub 2021 Aug 8.

Departmento de Psiquiatría, Geisel School of Medicine, Dartmouth College, Hanover, United States.

Introduction: Access to healthcare services involves a complex dynamic, where mental health conditions are especially disadvantaged, due to multiple factors related to the context and the involved stakeholders. However, a characterisation of this phenomenon has not been carried out in Colombia, and this motivates the present study.

Objectives: The objective of this study was to explore the causes that affect access to health services for depression and unhealthy alcohol use in Colombia, according to various stakeholders involved in the care process.

Methods: In-depth interviews and focus groups were conducted with health professionals, administrative professionals, users, and representatives of community health organisations in five primary and secondary-level institutions in three regions of Colombia. Subsequently, to describe access to healthcare for depression and unhealthy alcohol use, excerpts from the interviews and focus groups were coded through content analysis, expert consensus, and grounded theory. Five categories of analysis were created: education and knowledge of the health condition, stigma, lack of training of health professionals, culture, and structure or organisational factors.

Results: We characterised the barriers to a lack of illness recognition that affected access to care for depression or unhealthy alcohol use according to users, healthcare professionals and administrative staff from five primary and secondary care centres in Colombia. The groups identified that lack of recognition of depression was related to low education and knowledge about this condition within the population, stigma, and lack of training of health professionals, as well as to culture. For unhealthy alcohol use, the participants identified that low education and knowledge about this condition, lack of training of healthcare professionals, and culture affected its recognition, and therefore, healthcare access. Neither structural nor organisational factors seemed to play a role in the recognition or self-recognition of these conditions.

Conclusions: This study provides essential information for the search for factors that undermine access to mental health in the Colombian context. Likewise, it promotes the generation of hypotheses that can lead to the development and implementation of tools to improve care in the field of mental illness.
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http://dx.doi.org/10.1016/j.rcpeng.2021.06.008DOI Listing
July 2021

Scaling Up Science-Based Care for Depression and Unhealthy Alcohol Use in Colombia: An Implementation Science Project.

Psychiatr Serv 2021 Aug 4:appips202000041. Epub 2021 Aug 4.

Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire (Marsch, Bartels, Bell, Martinez Camblor, Cubillos, John, Lemley, Torrey); Department of Psychiatry, Pontificia Universidad Javeriana, Bogotá, Colombia (Gómez-Restrepo, Castro, Cárdenas Charry, Cepeda, Jassir, Suárez-Obando, Uribe); Hospital Universitario San Ignacio, Bogotá, Colombia (Gómez-Restrepo, Suárez-Obando); Department of Psychiatry, Dartmouth-Hitchcock, Lebanon, New Hampshire (Cubillos, Torrey); National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland (Williams).

Background: Mental disorders are a major cause of the global burden of disease and significantly contribute to disability and death. This challenge is particularly evident in low- and middle-income countries (LMICs), where >85% of the world's population live. Latin America is one region comprising LMICs where the burden of mental disorders is high and the availability of mental health services is low. This is particularly evident in Colombia, a country with a long-standing history of violence and associated mental health problems.

Methods: This article describes the design of a multisite implementation science project, "Scaling Up Science-Based Mental Health Interventions in Latin America" (also known as the DIADA project), that is being conducted in six primary care systems in Colombia. This project, funded via a cooperative agreement from the National Institute of Mental Health, seeks to implement and assess the impact of a new model for promoting widespread access to mental health care for depression and unhealthy alcohol use within primary care settings and building an infrastructure to support research capacity and sustainability of the new service delivery model in Colombia. This care model centrally harnesses mobile health technology to increase the reach of science-based mental health care for depression and unhealthy alcohol use.

Results: This initiative offers great promise to increase capacity for providing and sustaining evidence-based treatment for depression and unhealthy alcohol use in Colombia.

Next Steps: This project may inform models of care that can extend to other regions of Latin America or other LMICs.
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http://dx.doi.org/10.1176/appi.ps.202000041DOI Listing
August 2021

Relationship between the sociodemographic characteristics of participants in the DIADA project and the rate of compliance with follow-up assessments in the initial stage of the intervention.

Rev Colomb Psiquiatr (Engl Ed) 2021 Jul 21;50 Suppl 1:102-109. Epub 2021 Jul 21.

Departamento de Epidemiología Clínica y Bioestadística, Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá, Colombia; Departamento de Psiquiatría y Salud Mental, Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá, Colombia; Hospital Universitario San Ignacio, Bogotá, Colombia.

Objective: Analyse the relationship between the sociodemographic profile of the DIADA study participants and the rate of compliance with the follow-up assessments in the early stage of this project's intervention for depression and unhealthy alcohol use offered within primary care.

Methods: A non-experimental quantitative analysis was conducted. The sociodemographic data of DIADA [Detección y Atención Integral de Depresión y Abuso de Alcohol en Atención Primaria (Detection and Integrated Care for Depression and Alcohol Use in Primary Care)] study participants had been previously collected. At the time of the evaluation (September 12, 2019), only the participants who had been in the project for a minimum of 3 months were included. By using univariate (Chi-squared) analyses, we studied the association between participants' sociodemographic profile and their rate of compliance with the first follow-up assessment at 3 months after study initiation.

Results: At the date of the evaluation, 584 adult participants were identified, of which 389 had been involved in the project for more than 3 months. From the participants included, 320 performed the first follow-up, while 69 did not. The compliance rate to the first follow-up was 82.3% (95 % [CI] 78.1%-86%) and was not affected by: site location, age, sex, civil status, level of education, use of smartphone, PHQ9 score (measuring depression symptomatology) or AUDIT score (measuring harmful alcohol use). Participants who do not use a smartphone, from rural areas and with a lower socioeconomic status, tended to show higher compliance rates. Statistically significant associations were found; participants with lower job stability and a lack of access to the Internet showed higher compliance rates to the early initial follow-up assessment.

Conclusions: The compliance rate was high and generally constant in spite of the variability of the sociodemographic profiles of the participants, although several sub-groups of participants showed particularly high rates of compliance. These findings may suggest that integrating mental health into primary care allows the structural and financial barriers that hinder access to health in Colombia to be broken down by raising awareness about mental illnesses, their high prevalence and the importance of timely and accessible medical management.
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http://dx.doi.org/10.1016/j.rcpeng.2021.06.006DOI Listing
July 2021

Barriers and facilitators to the diagnosis and treatment of depression in primary care in Colombia: Perspectives of providers, healthcare administrators, patients and community representatives.

Rev Colomb Psiquiatr (Engl Ed) 2021 Jul 17;50 Suppl 1:64-72. Epub 2021 Jul 17.

Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, USA.

Introduction: Depression represents a major disease burden in Colombia. To better understand opportunities to improve access to mental healthcare in Colombia, a research team at Javeriana University conducted formative qualitative research to explore stakeholders' experiences with the integration of mental healthcare into the primary care system.

Methods: The research team conducted 16 focus groups and 4 in-depth interviews with patients, providers, health administrators and representatives of community organisations at five primary care clinics in Colombia, and used thematic analysis to study the data.

Results: Themes were organised into barriers and facilitators at the level of patients, providers, organisations and facilities. Barriers to the treatment of depression included stigma, lack of mental health literacy at the patient and provider level, weak links between care levels, and continued need for mental health prioritization at the national level. Facilitators to the management of depression in primary care included patient support systems, strong patient-provider relationships, the targeting of depression interventions and national depression guidelines.

Discussion: This study elucidates the barriers to depression care in Colombia, and highlights action items for further integrating depression care into the primary care setting.
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http://dx.doi.org/10.1016/j.rcpeng.2021.01.001DOI Listing
July 2021

Addressing harmful alcohol use in primary care in Colombia: Understanding the sociocultural context.

Rev Colomb Psiquiatr (Engl Ed) 2021 Jul 16;50 Suppl 1:73-82. Epub 2021 Jul 16.

Center for Technology and Behavioral Health, Department of Psychiatry, Geisel School of Medicine at Dartmouth College.

Harmful alcohol use is a public health problem worldwide, contributing to an estimated 5.1% of the global burden of illness. Screening and addressing at-risk drinking in primary care settings is an empirically supported health care intervention strategy to help reduce the burden of alcohol-use problems. In preparation for introducing screening and treatment for at-risk drinking in primary care clinics in Colombia, we conducted interviews with clinicians, clinic administrators, patients, and participants in Alcoholics Anonymous. Interviews were conducted within the framework of the Detección y Atención Integral de Depresión y Abuso de Alcohol en Atención Primaria (DIADA, [Detection and Integrated Care for Depression and Alcohol Use in Primary Care] www.project-diada.org) research project, and its qualitative phase that consisted of the collection of data from 15 focus groups, 6 interviews and field observations in 5 regional settings. All participants provided informed consent to participate in this research. Findings revealed the association of harmful alcohol use with a culture of consumption, within which it is learned and socially accepted practice. Recognition of harmful alcohol consumption includes a social context that influences its screening, diagnosis and prevention. The discussion highlights how, despite the existence of institutional strategies in healthcare settings and the awareness of the importance of at-risk drinking among health personnel, the recognition of the harmful use of alcohol as a pathology should be embedded in an understanding of historical, social and cultural dimensions that may affect different identification and care scenarios.
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http://dx.doi.org/10.1016/j.rcpeng.2020.11.004DOI Listing
July 2021

Characterizing the perceived stigma towards mental health in the early implementation of an integrated services model in primary care in Colombia. A qualitative analysis.

Rev Colomb Psiquiatr (Engl Ed) 2021 Jul 10;50 Suppl 1:91-101. Epub 2021 Jul 10.

Pontificia Universidad Javeriana, Bogotá, Colombia.

Background: Stigma is a sociocultural barrier to accessing mental health services and prevents individuals with mental health disorders from receiving mental health care. The Ministry of Health and Social Protection of Colombia acknowledges that a great number of people with mental disorders do not seek medical aid due to stigma.

Objectives: Characterise the perceived stigma towards mental health among the stakeholders involved in the early implementation of the DIADA project [Detección y Atención Integral de Depresión y Abuso de Alcohol en Atención Primaria (Detection and Integrated Care for Depression and Alcohol Use in Primary Care)]. Explore whether the implementation of this model can decrease stigma. Describe the impact of the implementation on the lives of patients and medical practice.

Materials And Methods: Eighteen stakeholders (7 patients, 5 physicians and 6 administrative staff) were interviewed and a secondary data analysis of 24 interview transcripts was conducted using a rapid analysis technique.

Results: The main effects of stigma towards mental health disorders included refusing medical attention, ignoring illness, shame and labelling. Half of the stakeholders reported that the implementation of mental health care in primary care could decrease stigma. All of the stakeholders said that the implementation had a positive impact.

Conclusions: The perceived stigma was characterised as social and aesthetic in nature. Communication and awareness about mental health is improving, which could facilitate access to mental health treatment and strengthen the doctor-patient relationship. Culture is important for understanding stigma towards mental health in the population studied.
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http://dx.doi.org/10.1016/j.rcpeng.2021.06.009DOI Listing
July 2021

Implementing a Redcap-based research data collection system for mental health.

Rev Colomb Psiquiatr (Engl Ed) 2021 Jul 10;50 Suppl 1:110-115. Epub 2021 Jul 10.

Departmento de Epidemiología Clínica y Estadística, Pontificia Universidad Javeriana, Colombia; Departmento de Psiquiatría y Salud Mental, Facultad de Medicina, Pontificia Universidad Javeriana, Colombia.

Background: The implementation of new technologies in medical research, such as novel big storage systems, has recently gained importance. Electronic data capture is a perfect example as it powerfully facilitates medical research. However, its implementation in resource-limited settings, where basic clinical resources, internet access, and human resources may be reduced might be a problem.

Methods: In this paper we described our approach for building a network architecture for data collection to achieve our objectives using a REDCap® tool in Colombia and provide guidance for data collection in similar settings.

Conclusions: REDCap is a feasible and efficient electronic data capture software to use in similar contexts to Colombia. The software facilitated the whole data management process and is a way to build research capacities in resourced-limited settings.
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http://dx.doi.org/10.1016/j.rcpeng.2021.06.004DOI Listing
July 2021

The DIADA project: A technology-based model of care for depression and risky alcohol use in primary care centres in Colombia.

Rev Colomb Psiquiatr (Engl Ed) 2021 Jul 7;50 Suppl 1:4-12. Epub 2021 Jul 7.

Department of Psychiatry, Dartmouth's Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire, United States.

Introduction: People with mental health conditions frequently attend primary care centers, but these conditions are underdiagnosed and undertreated. The objective of this paper is to describe the model and the findings of the implementation of a technology-based model of care for depression and unhealthy alcohol use in primary care centers in Colombia.

Methods: Between February 2018 and March 2020, we implemented a technology-based model of care for depression and unhealthy alcohol use, following a modified stepped wedge methodology, in six urban and rural primary care centers in Colombia. The model included a series of steps aimed at screening patients attending medical appointments with general practitioners and supporting the diagnosis and treatment given by the general practitioner. We describe the model, its implementation and the characteristics of the screened and assessed patients.

Results: During the implementation period, we conducted 22,354 screenings among 16,188 patients. The observed rate of general practitioner (GP)-confirmed depression diagnosis was 10.1% and of GP-confirmed diagnosis of unhealthy alcohol use was 1.3%. Patients with a depression diagnosis were primarily middle-aged women, while patients with unhealthy alcohol use were mainly young adult men.

Discussion: The provision of training and technology-based strategies to screen patients and support the decision-making of GPs during the medical appointment enhanced the diagnosis and care provision of patients with depression and unhealthy alcohol use. However, time constraints, as well as structural and cultural barriers, were challenges for the implementation of the model, and the model should take into account local values, policies and resources to guarantee its long-term sustainability. As such, the long-term sustainability of the model will depend on the alignment of different stakeholders, including decision-makers, institutions, insurers, GPs, patients and communities, to reduce the amount of patients seeking medical care whose mental health conditions remain undetected, and therefore untreated, and to ensure an appropriate response to the demand for mental healthcare that was revealed by the implementation of our model.
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http://dx.doi.org/10.1016/j.rcpeng.2020.11.005DOI Listing
July 2021

A characterisation of social media users within the primary care system in Colombia and predictors of their social media use to understand their health.

Rev Colomb Psiquiatr (Engl Ed) 2021 Jul 7;50 Suppl 1:42-51. Epub 2021 Jul 7.

Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire, United States.

Introduction: Social media use is growing in Latin America and is increasingly being used in innovative ways. This study sought to characterise the profile of social media users, among primary care patients in Colombia, and to assess predictors of their use of social media to search for health and mental health information (searching behaviour).

Methods: As part of a larger scale-up study, we surveyed 1580 patients across six primary care sites in Colombia about their social media use. We used chi-square and Student's t-tests to assess associations between demographic variables, social media use and searching behaviour, and a Chi-square Automatic Interaction Detector (CHAID) analysis to determine predictors of searching behaviour.

Results: In total, 44.4% of respondents reported that they were social media users. Of these, 35.7% used social media to search for health-related information and 6.6% used it to search for mental health-related information. While the profile of individuals who used social media to search for health-related information was similar to that of general social media users (the highest use was among women living in urban areas), the presence of mental health symptoms was a more important predictor of using social media to search for mental health-related information than demographic variables. Individuals with moderate-severe symptoms of anxiety reported a significantly higher percentage of searching than individuals without symptoms (12.5% vs. 5.2%).

Conclusions: Given that some individuals with mental health disorders turn to social media to understand their illness, social media could be a successful medium for delivering mental health interventions in Colombia.
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http://dx.doi.org/10.1016/j.rcpeng.2021.06.002DOI Listing
July 2021

The DIADA Project: A technology-based model of care for depression and risky alcohol use in Primary Care Centres in Colombia.

Rev Colomb Psiquiatr 2021 Jun 15;50 Suppl 1:4-13. Epub 2021 May 15.

Department of Psychiatry, Dartmouth's Geisel School of Medicine, Dartmouth College, Hanover (New Hampshire), Estados Unidos.

Introduction: People with mental health conditions frequently attend primary care centres, but these conditions are underdiagnosed and undertreated. The objective of this paper is to describe the model and the findings of the implementation of a technology-based model of care for depression and unhealthy alcohol use in primary care centres in Colombia.

Methods: Between February 2018 and March 2020, we implemented a technology-based model of care for depression and unhealthy alcohol use, following a modified stepped wedge methodology, in 6urban and rural primary care centres in Colombia. The model included a series of steps aimed at screening patients attending medical appointments with general practitioners and supporting the diagnosis and treatment given by the general practitioner. We describe the model, its implementation and the characteristics of the screened and assessed patients.

Results: During the implementation period, we conducted 22,354 screenings among 16,188 patients. The observed rate of general practitioner-confirmed depression diagnosis was 10.1% and of confirmed diagnosis of unhealthy alcohol use was 1.3%. Patients with a depression diagnosis were primarily middle-aged women, while patients with unhealthy alcohol use were mainly young adult men.

Discussion: The provision of training and technology-based strategies to screen patients and support the decision-making of general practitioners during the medical appointment enhanced the diagnosis and care provision of patients with depression and unhealthy alcohol use. However, time constraints, as well as structural and cultural barriers, were challenges for the implementation of the model, and the model should take into account local values, policies and resources to guarantee its long-term sustainability. As such, the long-term sustainability of the model will depend on the alignment of different stakeholders, including decision-makers, institutions, insurers, general practitioners, patients and communities, to reduce the amount of patients seeking medical care whose mental health conditions remain undetected, and therefore untreated, and to ensure an appropriate response to the demand for mental healthcare that was revealed by the implementation of our model.
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http://dx.doi.org/10.1016/j.rcp.2020.11.022DOI Listing
June 2021

Access barriers, self-recognition, and recognition of depression and unhealthy alcohol use: A qualitative study.

Rev Colomb Psiquiatr 2021 Jun 13;50 Suppl 1:55-66. Epub 2021 May 13.

Departmento de Psiquiatría, Geisel School of Medicine, Dartmouth College, Hanover, Estados Unidos.

Introduction: Access to healthcare services involves a complex dynamic, where mental health conditions are especially disadvantaged, due to multiple factors related to the context and the involved stakeholders. However, a characterisation of this phenomenon has not been carried out in Colombia, and this motivates the present study.

Objectives: The objective of this study was to explore the causes that affect access to health services for depression and unhealthy alcohol use in Colombia, according to various stakeholders involved in the care process.

Methods: In-depth interviews and focus groups were conducted with health professionals, administrative professionals, users, and representatives of community health organisations in five primary and secondary-level institutions in three regions of Colombia. Subsequently, to describe access to healthcare for depression and unhealthy alcohol use, excerpts from the interviews and focus groups were coded through content analysis, expert consensus, and grounded theory. Five categories of analysis were created: education and knowledge of the health condition, stigma, lack of training of health professionals, culture, and structure or organisational factors.

Results: We characterised the barriers to a lack of illness recognition that affected access to care for depression or unhealthy alcohol use according to users, healthcare professionals and administrative staff from five primary and secondary care centres in Colombia. The groups identified that lack of recognition of depression was related to low education and knowledge about this condition within the population, stigma, and lack of training of health professionals, as well as to culture. For unhealthy alcohol use, the participants identified that low education and knowledge about this condition, lack of training of healthcare professionals, and culture affected its recognition, and therefore, healthcare access. Neither structural nor organisational factors seemed to play a role in the recognition or self-recognition of these conditions.

Conclusions: This study provides essential information for the search for factors that undermine access to mental health in the Colombian context. Likewise, it promotes the generation of hypotheses that can lead to the development and implementation of tools to improve care in the field of mental illness.
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http://dx.doi.org/10.1016/j.rcp.2020.11.021DOI Listing
June 2021

Inoculation as a Tool for Attenuating Drought Stress in Sugarcane.

Front Plant Sci 2021 15;12:645542. Epub 2021 Apr 15.

Embrapa Soybean, Londrina, Brazil.

Drought stress is an important concern worldwide which reduces crop yield and quality. To alleviate this problem, has been used as a plant growth-promoting fungus capable of inducing plant tolerance to biotic and abiotic stresses. Here, we examined the effect of inoculation on sugarcane plant above and belowground development under drought stress and investigated the role of this fungus on inducing tolerance to drought at physiological and biochemical levels. The experiment was performed in pots under greenhouse conditions, with four treatments and four replicates. The treatments consisted of sugarcane plants inoculated or not with and grown under drought stress and adequate water availability. Drought-stressed sugarcane plants inoculated with changed the crop nutrition and chlorophyll and carotenoid concentrations, resulting in increased photosynthesis rate, stomatal conductance, and water use efficiency compared to the non-inoculated plants. In addition, the antioxidant metabolism also changed, increasing the superoxide dismutase and peroxidase enzyme activities, as well as the proline concentration and sugar portioning. These cascade effects enhanced the root and stalk development, demonstrating that inoculation is an important tool in alleviating the negative effects of drought stress in sugarcane. Future studies should be performed to elucidate if should be reapplied to the sugarcane ratoons.
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http://dx.doi.org/10.3389/fpls.2021.645542DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8082249PMC
April 2021

Teaching NeuroImages: MRI Abnormalities of Spinal Dural Arteriovenous Fistula in the Absence of Flow Voids.

Neurology 2021 Apr 26. Epub 2021 Apr 26.

Department of Imagiology, Neuroradiology Unit, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal

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http://dx.doi.org/10.1212/WNL.0000000000012053DOI Listing
April 2021

Barriers and facilitators to the diagnosis and treatment of depression in Primary Care in Colombia: Perspectives of providers, healthcare administrators, patients and community representatives.

Rev Colomb Psiquiatr 2021 Jun 23;50 Suppl 1:67-76. Epub 2021 Mar 23.

Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, Estados Unidos.

Introduction: Depression represents a major disease burden in Colombia. To better understand opportunities to improve access to mental healthcare in Colombia, a research team at Javeriana University conducted formative qualitative research to explore stakeholders' experiences with the integration of mental healthcare into the primary care system.

Methods: The research team conducted 16 focus groups and 4 in-depth interviews with patients, providers, health administrators and representatives of community organisations at 5 primary care clinics in Colombia, and used thematic analysis to study the data.

Results: Themes were organised into barriers and facilitators at the level of patients, providers, organisations and facilities. Barriers to the treatment of depression included stigma, lack of mental health literacy at the patient and provider level, weak links between care levels, and continued need for mental health prioritisation at the national level. Facilitators to the management of depression in primary care included patient support systems, strong patient-provider relationships, the targeting of depression interventions and national depression guidelines.

Discussion: This study elucidates the barriers to depression care in Colombia, and highlights action items for further integrating depression care into the primary care setting.
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http://dx.doi.org/10.1016/j.rcp.2021.01.001DOI Listing
June 2021

A characterisation of social media users within the Primary Care System in Colombia and predictors of their social media use to understand their health.

Rev Colomb Psiquiatr 2021 Jun 19;50 Suppl 1:44-54. Epub 2021 Mar 19.

Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire, Estados Unidos.

Introduction: Social media use is growing in Latin America and is increasingly being used in innovative ways. This study sought to characterise the profile of social media users, among primary care patients in Colombia, and to assess predictors of their use of social media to search for health and mental health information (searching behaviour).

Methods: As part of a larger scale-up study, we surveyed 1,580 patients across six primary care sites in Colombia about their social media use. We used chi-square and Student's t-tests to assess associations between demographic variables, social media use and searching behaviour, and a Chi-square Automatic Interaction Detector (CHAID) analysis to determine predictors of searching behaviour.

Results: In total, 44.4% of respondents reported that they were social media users. Of these, 35.7% used social media to search for health-related information and 6.6% used it to search for mental health-related information. While the profile of individuals who used social media to search for health-related information was similar to that of general social media users (the highest use was among women living in urban areas), the presence of mental health symptoms was a more important predictor of using social media to search for mental health-related information than demographic variables. Individuals with moderate-severe symptoms of anxiety reported a significantly higher percentage of searching than individuals without symptoms (12.5% vs. 5.2%).

Conclusions: Given that some individuals with mental health disorders turn to social media to understand their illness, social media could be a successful medium for delivering mental health interventions in Colombia.
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http://dx.doi.org/10.1016/j.rcp.2020.12.010DOI Listing
June 2021

Relationship between the sociodemographic characteristics of participants in the DIADA Project and the rate of compliance with follow-up assessments in the initial stage of the intervention.

Rev Colomb Psiquiatr 2021 Jun 15;50 Suppl 1:106-113. Epub 2021 Mar 15.

Departamento de Epidemiología Clínica y Bioestadística, Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá, Colombia; Departamento de Psiquiatría y Salud Mental, Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá, Colombia; Hospital Universitario San Ignacio, Bogotá, Colombia.

Objective: Analyse the relationship between the sociodemographic profile of the DIADA study participants and the rate of compliance with the follow-up assessments in the early stage of this project's intervention for depression and unhealthy alcohol use offered within primary care.

Methods: A non-experimental quantitative analysis was conducted. The sociodemographic data of DIADA [Detección y Atención Integral de Depresión y Abuso de Alcohol en Atención Primaria (Detection and Integrated Care for Depression and Alcohol Use in Primary Care)] study participants had been previously collected. At the time of the evaluation (September 12, 2019), only the participants who had been in the project for a minimum of three months were included. By using univariate (Chi-squared) analyses, we studied the association between participants' sociodemographic profile and their rate of compliance with the first follow-up assessment at three months after study initiation.

Results: At the date of the evaluation, 584 adult participants were identified, of which 389 had been involved in the project for more than three months. From the participants included, 320 performed the first follow-up, while 69 did not. The compliance rate to the first follow-up was 82.3% (CI 95% 78.1%-86%) and was not affected by: site location, age, sex, civil status, level of education, use of smartphone, PHQ9 score (measuring depression symptomatology) or AUDIT score (measuring harmful alcohol use). Participants who do not use a smartphone, from rural areas and with a lower socioeconomic status, tended to show higher compliance rates. Statistically significant associations were found; participants with lower job stability and a lack of access to the Internet showed higher compliance rates to the early initial follow-up assessment.

Conclusions: The compliance rate was high and generally constant in spite of the variability of the sociodemographic profiles of the participants, although several sub-groups of participants showed particularly high rates of compliance. These findings may suggest that integrating mental health into primary care allows the structural and financial barriers that hinder access to health in Colombia to be broken down by raising awareness about mental illnesses, their high prevalence and the importance of timely and accessible medical management.
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http://dx.doi.org/10.1016/j.rcp.2020.11.019DOI Listing
June 2021

Characterizing the perceived stigma towards mental health in the early implementation of an integrated services model in Primary Care in Colombia. A qualitative analysis.

Rev Colomb Psiquiatr 2021 Jun 23;50 Suppl 1:95-105. Epub 2021 Feb 23.

Departamento de Epidemiología Clínica y Bioestadística, Pontificia Universidad Javeriana, Bogotá DC, Colombia; Departamento de Psiquiatría y Salud Mental, Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá DC, Colombia; Hospital Universitario San Ignacio, Bogotá DC, Colombia.

Background: Stigma is a sociocultural barrier to accessing mental health services and prevents individuals with mental health disorders from receiving mental health care. The Ministry of Health and Social Protection of Colombia acknowledges that a great number of people with mental disorders do not seek medical aid due to stigma.

Objectives: Characterise the perceived stigma towards mental health among the stakeholders involved in the early implementation of the DIADA project [Detección y Atención Integral de Depresión y Abuso de Alcohol en Atención Primaria (Detection and Integrated Care for Depression and Alcohol Use in Primary Care)]. Explore whether the implementation of this model can decrease stigma. Describe the impact of the implementation on the lives of patients and medical practice.

Materials And Methods: Eighteen stakeholders (7 patients, 5 physicians and 6 administrative staff) were interviewed and a secondary data analysis of 24 interview transcripts was conducted using a rapid analysis technique.

Results: The main effects of stigma towards mental health disorders included refusing medical attention, ignoring illness, shame and labelling. Half of the stakeholders reported that the implementation of mental health care in primary care could decrease stigma. All of the stakeholders said that the implementation had a positive impact.

Conclusions: The perceived stigma was characterised as social and aesthetic in nature. Communication and awareness about mental health is improving, which could facilitate access to mental health treatment and strengthen the doctor-patient relationship. Culture is important for understanding stigma towards mental health in the population studied.
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http://dx.doi.org/10.1016/j.rcp.2020.11.017DOI Listing
June 2021

Addressing harmful alcohol use in Primary Care in Colombia: Understanding the sociocultural context.

Rev Colomb Psiquiatr 2021 Jun 25;50 Suppl 1:77-86. Epub 2021 Feb 25.

Center for Technology and Behavioral Health, Dartmouth College, Hanover, New Hampshire, United States.

Harmful alcohol use is a public health problem worldwide, contributing to an estimated 5.1% of the global burden of illness. Screening and addressing at-risk drinking in primary care settings is an empirically supported health care intervention strategy to help reduce the burden of alcohol-use problems. In preparation for introducing screening and treatment for at-risk drinking in primary care clinics in Colombia, we conducted interviews with clinicians, clinic administrators, patients, and participants in Alcoholics Anonymous. Interviews were conducted within the framework of the Detección y Atención Integral de Depresión y Abuso de Alcohol en Atención Primaria (DIADA [Detection and Integrated Care for Depression and Alcohol Use in Primary Care] www.project-diada.org) research project, and its qualitative phase that consisted of the collection of data from 15 focus groups, 6 interviews and field observations in 5 regional settings. All participants provided informed consent to participate in this research. Findings revealed the association of harmful alcohol use with a culture of consumption, within which it is learned and socially accepted practice. Recognition of harmful alcohol consumption includes a social context that influences its screening, diagnosis and prevention. The discussion highlights how, despite the existence of institutional strategies in healthcare settings and the awareness of the importance of at-risk drinking among health personnel, the recognition of the harmful use of alcohol as a pathology should be embedded in an understanding of historical, social and cultural dimensions that may affect different identification and care scenarios.
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http://dx.doi.org/10.1016/j.rcp.2020.11.016DOI Listing
June 2021

Partitioning β-diversity reveals that invasions and extinctions promote the biotic homogenization of Chilean freshwater fish fauna.

PLoS One 2020 8;15(9):e0238767. Epub 2020 Sep 8.

Center of Applied Ecology and Sustainability, Pontificia Universidad Católica de Chile, Santiago, Chile.

Aim: Exotic species' introductions together with extinction of native species represent the main mechanisms driving biotic homogenization of freshwater fish assemblages around the world. While generally ichtyofaunistic realms transit towards biotic homogenization, for conservation purposes it is essential to understand what specific mechanisms are promoting it on particular areas or regions. Here, we report the occurrence of biotic homogenization in 29 Chilean watersheds, analyzing its β-diversity (including turnover and nestedness) and predicting future trends.

Location: Continental Chile (18o-56o S).

Methods: We determined fish composition per basin for historical and current assemblages; extant native, exotic, and extinct species were recorded as 1 (presence) or 0 (absence) in two matrices basins × species. For each matrix, we calculated the turnover (βsim), nestedness (βnes), and β-diversity (βsor); then, we obtained Δβsim, Δβnes, and Δβsor, as the arithmetical difference between basin pairs over time. In addition, we search for explanatory variables correlating Δβsim, Δβnes, and Δβsor with geographical and land use variables. Finally, simulating events of species introduction (i.e., invasion) and extinction, we generated 15 hypothetical assemblages, looking to establish future trends towards biotic change in Chilean basins.

Results: Species turnover and β-diversity significantly decreased from historical to current assemblages (Δβsim = -0.084; Δβsor = -0.061, respectively), while the species nestedness did not show significant changes (Δβnes = 0.08). Biotic changes have been driven mainly by the introduction of 28 exotic species, with a minor role of extinctions (one species) and translocations (0 species) of native species. Changes in β-diversity were negatively correlated with area, elevation, and geographical distance between basins but not with land-use nor human population. Finally, the analysis of 15 future assemblages predicts a significant decrease of β-diversity and turnover, and an increase for species nestedness, this time promoted by an increase in the extinction of native species.

Main Conclusion: Chilean basins show a significant decrease of the distributional β-diversity and species turnover of the freshwater fish fauna, evidencing a trend towards biotic homogenization. This trend is shared with other Neotropical basins; however, specific mechanisms driving it show different magnitude. Changes in the β-diversity components do not show correlation with variables associated to land use, thus suggesting that casual introductions of freshwater fishes in Chile follow an opportunistic mode related to commercial use. According to future scenarios simulated, biotic homogenization should increase further, mainly as consequence of increased native extinctions.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0238767PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7478641PMC
November 2020

Mean platelet volume and mechanical thrombectomy.

J Stroke Cerebrovasc Dis 2020 Aug 9;29(8):104971. Epub 2020 Jun 9.

Stroke Unit, Neurology Department, Centro Hospitalar Vila Nova de Gaia/Espinho, Rua Conceição Fernandes, 4434-502 Vila Nova de Gaia. Electronic address:

Background And Purpose: Mean Platelet Volume (MPV) is a marker of platelet activity and it is an independent predictor for long-term outcome in stroke patients. The aim of this study was to evaluate the association between baseline MPV value and clinical outcome at 90-days in anterior circulation stroke and large vessel occlusion (LVO) patients submitted to mechanical thrombectomy (MT).

Methods: We conducted a prospective observational cohort study in acute ischemic stroke (AIS) patients submitted to MT between January 2017 and May 2018. MPV was measured at admission. Patients were initially stratified into two groups according to the mean MPV level. We also compared groups that were stratified according to the MPV cut-off obtained by Peng F et al (10,4 fL) and performed analyses among MPV terciles.

Results: A total of 129 patients were included. Mean level of MPV was 10,9 fL. Patients with embolic stroke of undetermined source (ESUS) had significantly higher rates of good outcome at 3 months compared with large-artery atherosclerotic disease and cardioembolism [(82,9%) vs (78,3%) vs (55,2%); p=0,009]. There were no statistically significant differences in the mean MPV value (p=0,222), successful recanalization (p=0,464) and mortality (p=0,343) when evaluated for all TOAST etiologies. There were no statistically significant differences between the two groups according to the MPV level (10,4 and 10,9 fL) or between the terciles (lowest tertile <10,3 fL, median 10,3 - 11,3 fL, highest >11,3fL) concerning functional outcome at 3 months (p=0,357; p=0,24 and p=0,558, respectively), successful recanalization (p=0,108; p=0,582 and p=0,899, respectively) or mortality at 3 months (p=0,465; p=0,061 and p=0,484, respectively).

Conclusion: Our study did not find an association between elevated MPV and worse outcome at 3 months in patients with acute anterior circulation stroke and LVO treated with MT. Since ischemic strokes have different pathophysiologic mechanisms, MPV may have distinct prognostic value according to each stroke etiology.
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http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2020.104971DOI Listing
August 2020

Double stenting in T configuration with safety micro-guidewire technique in a complex middle cerebral artery stenosis.

Neuroradiology 2020 Jun 20;62(6):757-760. Epub 2020 Mar 20.

Neuroradiology Department, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal.

Intracranial arterial stenosis is a frequently misdiagnosed cause of ischemic stroke, associated with high rates of recurrence under medical therapy alone. Endovascular intracranial angioplasty and stenting has increasingly been used worldwide for treatment of symptomatic intracranial stenoses, despite controversial results of the first randomized trials. Lesion morphology and etiology must be considered during endovascular treatment planning. Complex morphologies can lead to serious complications during the endovascular procedure. We present a case of a symptomatic complex middle cerebral artery stenosis that was successfully treated with a double stenting in T configuration, using a safety micro-guidewire technique. During follow-up, intracranial Doppler revealed a non-significant residual stenosis and the patient remained asymptomatic.
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http://dx.doi.org/10.1007/s00234-020-02400-4DOI Listing
June 2020

Implementing Technology-Supported Care for Depression and Alcohol Use Disorder in Primary Care in Colombia: Preliminary Findings.

Psychiatr Serv 2020 07 10;71(7):678-683. Epub 2020 Mar 10.

Department of Psychiatry (Torrey, Bartels, Cubillos, Marsch) and Department of Biomedical Data Science (Camblor), Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; Department of Clinical Epidemiology and Biostatistics (Cepeda, Castro, Gómez-Restrepo), Institute of Human Genetics (Suárez Obando), and Department of Psychiatry and Mental Health (Uribe-Restrepo, Gómez-Restrepo), Pontificia Universidad Javeriana, Bogotá, Colombia; Office for Research on Disparities and Global Mental Health, National Institute of Mental Health, Bethesda, Maryland (Williams).

Objective: Depression and alcohol use disorder are among the most common causes of disability and death worldwide. Health care systems are seeking ways to leverage technology to screen, evaluate, and treat these conditions, because workforce interventions alone, particularly in low- and middle-income countries, are insufficient. This article reports data from the first year of implementation of a technology-supported, systematic approach to identify and care for persons with these disorders in primary care in Colombia.

Methods: A care process that includes waiting room kiosks to screen primary care patients, decision support tablets to guide doctors in diagnosis and treatment, and access to digital therapeutics as a treatment option was implemented in two primary care clinics, one urban and one in a small town. The project collected data on the number of people screened, diagnosed, and engaged in the research and their demographic characteristics.

Results: In the first year, 2,656 individuals were screened for depression and unhealthy alcohol use in the two clinics. Primary care doctors increased the percentage of patients diagnosed as having depression and alcohol use disorder from next to 0% to 17% and 2%, respectively.

Conclusions: Early experience with implementing technology-supported screening and decision support for depression and alcohol use disorder into the workflow of busy primary care clinics in Colombia indicates that this care model is feasible and leads to dramatically higher rates of diagnoses of these conditions. Diagnosis in these settings appeared to be easier for depression than for alcohol use disorder.
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http://dx.doi.org/10.1176/appi.ps.201900457DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7332379PMC
July 2020

Ultra-early improvement after endovascular thrombectomy and long-term outcome in anterior circulation acute ischemic stroke.

J Neurol Sci 2020 May 3;412:116665. Epub 2020 Jan 3.

Neurology Department, Centro Hospitalar Vila Nova de Gaia/Espinho, Rua Conceição Fernandes 1079, 4434-502 Vila Nova de Gaia, Portugal; Stroke Unit, Centro Hospitalar Vila Nova de Gaia/Espinho, Rua Conceição Fernandes 1079, 4434-502 Vila Nova de Gaia, Portugal. Electronic address:

Background: The use of post-treatment measures after acute ischemic stroke is important to predict good functional outcome. The most studied is 24 h National Institutes of Health Stroke Scale (NIHSS) score and existing literature is scarce regarding the use of earlier indicators, namely NIHSS immediately after endovascular thrombectomy (EVT). We hypothesized that an immediate neurological improvement after EVT, that we called ultra-early neurological improvement (UENI), would be a reliable functional independence predictor in anterior circulation acute ischemic stroke patients.

Methods: We included 296 anterior circulation stroke patients who received EVT at our institution between January 2015 and December 2017. We obtained post-EVT NIHSS score in the angiography room. UUENI was defined as a ≥ 4 point decrease in post-EVT NIHSS score relatively to baseline or post-EVT NIHSS score of 0-1. Patients' functional outcome was assessed using the modified Rankin Scale at 3 months. The ability of UENI to predict good functional outcome was assessed using logistic regression analysis.

Results: A total of 155 (52.4%) patients presented UENI. This group of patients achieved a statistically significant higher rate of functional independence (70.3% vs 46.8%, OR crude 2.69, 95% CI 1.67-4.34). After adjusting for potential confounders, the UENI showed to be an independent predictor of good outcome, with UENI patients having 4.61 times the probability of obtaining good outcome compared to patients without UENI.

Conclusions: UENI is useful in outcome prediction in patients with anterior circulation stroke treated with EVT, with the advantage that it can be assessed at an ultra-early stage.
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http://dx.doi.org/10.1016/j.jns.2020.116665DOI Listing
May 2020

Perspectives, Experiences, and Practices in the Use of Digital Information Technologies in the Management of Depression and Alcohol Use Disorder in Health Care Systems in Colombia.

Qual Health Res 2020 05 13;30(6):906-916. Epub 2020 Feb 13.

Department of Epidemiology and Biostatistics, School of Medicine, Pontificia Universidad Javeriana, Bogota, Colombia.

Digital information technologies are increasingly used in the treatment of mental health disorders. Through this qualitative study, researchers illuminated perspectives, experiences, and practices among diverse stakeholders in the use of digital information technologies in the management of depression and alcohol use disorders in Colombia. In-depth interviews and focus groups were conducted in five primary care institutions across Colombia. Thematic analysis was used to analyze the data. The use of technology in the treatment of mental health disorders can facilitate the , and , as well as Potential barriers to the use of technology in this setting include challenges of , and This study can inform the implementation of digital information technologies in the care of depression and problematic alcohol use within health care systems in Colombia.
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http://dx.doi.org/10.1177/1049732320902460DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7265234PMC
May 2020

Assessing the Integration of Behavioral Health Services in Primary Care in Colombia.

Adm Policy Ment Health 2020 05;47(3):435-442

Departamento de Epidemiología Clínica y Bioestadística, Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá, Colombia.

Integration of behavioral health care into primary care can improve health and economic outcomes. This study adapted the Behavioral Health Integration in Medical Care (BHIMC) index to the Colombian context and assessed the baseline level of behavioral health integration in a sample of primary care organizations. The BHIMC was able to detect the capacity to provide integrated behavioral care in Colombian settings. Results indicate a minimal to partial integration level across all sites, and that it is possible to measure the degree of integrated care capacity and identify improvement areas for better behavioral health care provision.
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http://dx.doi.org/10.1007/s10488-019-01002-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7159997PMC
May 2020

Germination and seedling growth of the Chilean native grass Polypogon australis in soil polluted with diesel oil.

Int J Phytoremediation 2019 7;21(1):14-18. Epub 2019 Feb 7.

a Department of Biology, Faculty of Chemistry and Biology , Universidad de Santiago de Chile , Estación Central , Chile.

The purpose of this study was to evaluate the ability of Polypogon australis, a Chilean native grass that colonizes copper polluted sites, to germinate and grow in soil contaminated with diesel oil. The effect of increasing proportions of diesel in soil (0.5%, 1%, 2%, and 5%) on the cumulative germination and growth of plants was measured. The relative seed germination (RSG), relative root growth (RRG), germination index (GI), and the effective concentration (EC) were calculated. The cumulative germination in soil polluted with 0%, 0.5%, 1%, and 2% of diesel oil in soil was 93.3%, 85.5%, 99%, and 78.5%, respectively, showing no significant differences between the treatments (p > 0.05). A proportion of 5% of diesel in the soil reduced the germination of P. australis by 50%, compared to the control. The growth of leaves and roots of the plants germinated in 5% of diesel was reduced by 30% compared to the control, with a 34% survival rate observed on day 40. The calculated EC of diesel for P. australis was 4.5%. P. australis germinated and grew on all diesel concentration used in the experiments. The species was classified as a tolerant to diesel oil.
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http://dx.doi.org/10.1080/15226514.2018.1523868DOI Listing
September 2019

Primary Thrombectomy Versus Combined Mechanical Thrombectomy and Intravenous Thrombolysis in Large Vessel Occlusion Acute Ischemic Stroke.

J Stroke Cerebrovasc Dis 2019 Mar 22;28(3):627-631. Epub 2018 Nov 22.

Neurology Department, Centro Hospitalar de Vila Nova de Gaia/Espinho, Portugal; Stroke Unit, Centro Hospitalar de Vila Nova de Gaia/Espinho, Portugal.

Mechanical thrombectomy (MT) in combination with intravenous thrombolysis (IVT) is the standard of care for patients with acute ischemic stroke with anterior circulation large vessel occlusion. The particular benefit of IVT in these patients is unknown. We performed a retrospective analysis of patients submitted to MT at our center between January 2015 and June 2017. Functional outcome was prospectively assessed using modified Rankin scale (mRS) at 3 months. A total of 234 patients were enrolled, 152 (65%) in the combined treatment group and 82 (35%) in the direct MT group. Patients receiving combined treatment had a higher frequency of intracranial internal carotid artery occlusion (48 [31.6%] versus 16 [19.5%], P = .048) and significantly less strokes of cardioembolic etiology (72 [47.4%] versus 57 [69.5%], P = .01). Other baseline characteristics did not differ between the 2 groups. Good functional outcome at 3 months (mRS 0-2) was trending toward being higher in patients in the combined treatment group (98 [64.9%] versus 42 [52.5%], P = .066). Rates of symptomatic intracranial hemorrhage (5 [3.3%] versus 4 [4.9%], P = .723) and mortality (15 [9.9%] versus 14 [17.5%], P = .099) did not differ between groups. In multivariate logistic regression analysis, we did not find a statistically significant association between the use of IVT and any of the outcomes studied. Our results suggest that combined treatment carries similar effectiveness and safety than direct MT. Randomized controlled trials regarding this subject are warranted.
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http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2018.11.002DOI Listing
March 2019

NCCT and CTA-based imaging protocol for endovascular treatment selection in late presenting or wake-up strokes.

J Neurointerv Surg 2019 Feb 10;11(2):200-203. Epub 2018 Aug 10.

Department of Imagiology, Neuroradiology Unit, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal.

Introduction: Recently, the benefit of selecting patients for endovascular treatment (EVT) beyond the 6-hour time window using a tissue-based approach was demonstrated in two randomized trials. The optimal imaging protocol for selecting patients is under debate, and it is still unknown if a simpler and faster protocol may adequately select patients with wake-up stroke (WUS) and late-presenting stroke (LPS) for EVT.

Objective: To compare outcomes of patients submitted to EVT presenting within 6 hours of symptom onset or 6-24 hours after last seen well, selected using non-contrast computed tomography (NCCT) and CT angiography (CTA).

Methods: An observational study was performed, which included consecutive patients with anterior circulation ischemic stroke with large vessel occlusion treated with EVT. Patients presenting within 6 hours were treated if their NIH Stroke Scale (NIHSS) score was ≥6 and Alberta Stroke Program Early CT score (ASPECTS) was ≥6, while patients presenting with WUS or 6-24 hours after last seen well (WUS/LPS) were treated if their NIHSSscore was ≥12 and ASPECTS was ≥7.

Results: 249 patients were included, 63 of whom were in the WUS/LPS group. Baseline characteristics were similar between groups, except for longer symptom-recanalization time, lower admission NIHSS (16 vs 17, P=0.038), more frequent tandem occlusions (25.4% vs 11.8%, P=0.010), and large artery atherosclerosis etiology (22.2% vs 11.8%, P=0.043) in the WUS/LPS group. No differences in symptomatic intracranial hemorrhage, peri-procedural complications or mortality were found between groups. Three-month functional independence was similar in both groups (65.1% in WUS/LPS vs 57.0% in ≤6 hours, P=0.259) and no differences were found after adjustment for confounders.

Conclusions: This real-world observational study suggests that EVT may be safe and effective in patients with WUS and LPS selected using clinical-core mismatch (high NIHSS/high ASPECTS in NCCT).
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http://dx.doi.org/10.1136/neurintsurg-2018-014051DOI Listing
February 2019

Time to Reset the Definition of Successful Revascularization in Endovascular Treatment of Acute Ischemic Stroke.

Cerebrovasc Dis 2018 31;46(1-2):40-45. Epub 2018 Jul 31.

Department of Neurology, Vila Nova de Gaia, Portugal.

Background: A 2013 consensus statement recommended the use of the modified Treatment In Cerebral Ischemia (mTICI) scale to evaluate angiographic revascularization after endovascular treatment (EVT) of acute ischemic stroke due to its higher inter-rater agreement and capacity of clinical outcome prediction. The current definition of successful revascularization includes the achievement of grades mTICI 2b or 3. However, mTICI 2b grade encompasses a large heterogeneity of revascularization states, and prior studies suggested that the magnitude of benefit derived from mTICI 2b and mTICI 3 does not seem to be equivalent. In a way to restrain the referred heterogeneity, Goyal et al. [J Neurointerv Surg 2014; 6: 83-86] proposed a revised mTICI scale that includes a 2c grade (rTICI).

Methods: Retrospective analysis of prospectively collected data from consecutive cases of EVT for anterior circulation large-vessel occlusion, performed between January 2015 and July 2017. Patients with mTICI 2b or 3 grades were reclassified according to the rTICI scale, and the outcomes between the 3 revascularization grades (rTICI 2b, 2c, 3) compared.

Results: Our study population of 226 patients (64 rTICI 2b, 30 rTICI 2c, 132 rTICI 3) has a mean age of 71 years, 48.2% males, median baseline NIHSS of 16 (13-19) and ASPECTS of 8 (7-9). The 3 revascularization grades are represented by homogeneous populations. Logistic regression analysis showed statistically significant higher rates of functional independence at 3 months (65.9 vs. 50.0%; adjusted OR 0.39, 95% CI 0.18-0.86), with lower rates of mortality (8.3 vs. 15.6%; adjusted OR 3.54, 95% CI 1.14-10.97) and intracranial hemorrhage (ICH) in rTICI 3 than 2b groups. When comparing rTICI 3 with 2c groups, there were only statistically significant differences in the total ICH rate (8.3 vs. 26.7%; adjusted OR 7.08, 95% CI 1.80-27.82) but not in symptomatic ICH.

Conclusions: These results corroborate the scarce prior findings suggesting that patients with rTICI 2c grade should be reported separately, since they have similar outcomes to rTICI 3, and better than rTICI 2b patients. Therefore, we suggest resetting the angiographic revascularization endpoint to perfect revascularization (rTICI 2c or 3 grades), a target that neurointerventionalists should strive to achieve.
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http://dx.doi.org/10.1159/000491553DOI Listing
June 2019
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