Partnering With Community Health Workers to Address COVID-19 Health Inequities: Experiences of the California Alliance Against COVID-19.

With funding from the National Institutes of Health's Community Engagement Alliance, starting in fall 2020, 11 academic medical centers and 75 community partners came together as the California Alliance Against COVID-19 to address COVID-19 inequities in California. Using data from focus groups, statewide meetings, and a statewide partner survey, we describe how promotoras and community health workers (P/CHWs; n = 540) helped to promote access to COVID-19 information, testing, and vaccination. We highlight opportunities to promote health equity among other public health collaborators with a P/CHW model. (Am J Public Health. 2024;114(S1):S45-S49. https://doi.org/10.2105/AJPH.2023.307471).

Continuum of Trauma: Fear and Mistrust of Institutions in Communities of Color During the COVID-19 Pandemic.

Historical, cultural, and social trauma, along with social determinants of health (SDOH), shape health outcomes, attitudes toward medicine, government, and health behaviors among communities of color in the United States (U.S.). This study explores how trauma and fear influence COVID-19 testing and vaccination among Black/African American, Latinx/Indigenous Latin American, and Native American/Indigenous communities. Leveraging community-based participatory research methods, we conducted 11 virtual focus groups from January to March of 2021 with Black/African American (n = 4), Latinx/Indigenous Latin American (n = 4), and Native American/Indigenous (n = 3) identifying community members in Inland Southern California. Our team employed rapid analytic approaches (e.g., template and matrix analysis) to summarize data and identify themes across focus groups and used theories of intersectionality and trauma to meaningfully interpret study findings. Historical, cultural, and social trauma induce fear and mistrust in public health and medical institutions influencing COVID-19 testing and vaccination decisions in communities of color in Inland Southern California. This work showcases the need for culturally and structurally sensitive community-based health interventions that attend to the historical, cultural, and social traumas unique to racial/ethnic minority populations in the U.S. that underlie fear and mistrust of medical, scientific, and governmental institutions.

Análisis estadístico implicativo para identificar factores pronósticos de mortalidad por linfomas en niños y adolescentes

Fundamento: el análisis estadístico implicativo surgió en los años 80 para resolver problemas de la didáctica de las matemáticas. Recientemente se fundamentó su empleo en las Ciencias Médicas para identificar factores de riesgo y pronósticos. Objetivo: evaluar la utilidad del análisis estadístico implicativo en la identificación de los factores pronósticos que más inciden en la mortalidad por linfomas en niños y adolescentes. Método: se realizó un estudio de casos y controles en niños y adolescentes con diagnóstico de linfoma Hodgkin y no Hodgkin atendidos en el Hospital Docente Pediátrico Sur Dr. Antonio María Béguez César de Santiago de Cuba en el período de enero 2008 a enero 2021. Se analizó como variable dependiente el estado del paciente fallecido o vivo al momento del estudio y como covariables se tomaron: el estadio de mal pronóstico, la presencia de síntomas B, el subtipo histológico, la presencia de tres o más sitios extraganglionares, la metástasis, edad y presencia de masa tumoral. Se aplicaron dos técnicas estadísticas, la regresión logística binaria y el análisis estadístico implicativo. Resultados en los casos fue más frecuente el linfoma no Hodgkin mientras que en los controles predominó el Hodgkin. Ambas técnicas reconocieron el subtipo histológico y la afectación extraganglionar como factores pronósticos desfavorables. El análisis estadístico implicativo reconoció además el estadio y la presencia de metástasis. Conclusión: el análisis estadístico implicativo es una técnica que complementa la regresión logística binaria en la identificación de factores pronósticos, lo que permite mejor comprensión de la causalidad.

Background: the implicative statistical analysis arose in the 80s to solve problems in the didactics of mathematics. Its use in the Medical Sciences to identify risk factors and prognoses was recently founded. Objective: to evaluate the usefulness of the implicative statistical analysis in the identification of the prognostic factors that most affect mortality from lymphomas in children and adolescents. Method: a case-control study was carried out in children and adolescents diagnosed with Hodgkin and non-Hodgkin lymphoma treated at the Dr. Antonio María Béguez César Sur Pediatric Teaching Hospital in Santiago de Cuba from January 2008 to January 2021. The state of the deceased or alive patient at the time of the study was analyzed as the dependent variable and the following were taken as covariates: poor prognosis stage, presence of B symptoms, histological subtype, presence of three or more extranodal sites, metastasis, age and presence of tumor mass. Two statistical techniques were applied: binary logistic regression and implicative statistical analysis. Results: non-Hodgkin's lymphoma was more frequent in the cases, while Hodgkin's lymphoma predominated in the controls. Both techniques recognized the histological subtype and extranodal involvement as unfavorable prognostic factors. The implicative statistical analysis also recognized the stage and the presence of metastases. Conclusion: the implicative statistical analysis is a technique that complements the binary logistic regression in the identification of prognostic factors, which allows a better understanding of causality.

Creating Cultures of Health in the Academy: Bringing Together Top-Down and Ground-Up Approaches.

This article reports on a 3-year longitudinal study focused on the impact of cross-sector, collective impact approaches to creating cultures of campus health. The study sought to understand the integration of health and well-being concepts into university operations, including business practices and policies, as well as the contribution of public health initiatives focused on health-promoting universities to creating cultures of campus health for students, staff, and faculty. Research was carried out from spring 2018 to spring 2020 via focus group data collection and rapid qualitative analysis involving template and matrix analysis. A total of 18 focus groups were conducted across the 3-year study, six with students, eight with staff, and four with faculty. The initial cohort included 70 participants: 26 students, 31 staff, and 13 faculty. Qualitative analysis findings indicate a general pattern of change over time from a primary focus on well-being characterized by programs and services (e.g., fitness classes) to policy and structural-level interventions (e.g., stairwell beautification and hydration stations) promoting well-being for all. Grass-top and grassroots leadership and action were instrumental to changes in working and learning environments, policies, and campus environment/infrastructure. This work contributes to the growing literature on health-promoting universities and colleges and demonstrates the critical role of both top-down and ground-up approaches and leadership efforts to create more equitable and sustainable cultures of campus health and well-being.

The Role of Anti-Racist Community-Partnered Praxis in Implementing Restorative Circles Within Marginalized Communities in Southern California During the COVID-19 Pandemic.

The COVID-19 pandemic has exacerbated the adverse influence of structural racism and discrimination experienced by historically marginalized communities (e.g., Black, Latino/a/x, Indigenous, and transgender people). Structural racism contributes to trauma-induced health behaviors, increasing exposure to COVID-19 and restricting access to testing and vaccination. This intersection of multiple disadvantages has a negative impact on the mental health of these communities, and interventions addressing collective healing are needed in general and in the context of the COVID-19 pandemic. The Share, Trust, Organize, and Partner COVID-19 California Alliance (STOP COVID-19 CA), a statewide collaborative of 11 universities and 75 community partners, includes several workgroups to address gaps in COVID-19 information, vaccine trial participation, and access. One of these workgroups, the Vaccine Hesitancy Workgroup, adopted an anti-racist community-partnered praxis to implement restorative circles in historically marginalized communities to facilitate collective healing due to structural racism and the COVID-19 pandemic. The project resulted in the development of a multilevel pre-intervention restorative process to build or strengthen community-institutional partnerships when procurement of funds has been sought prior to community partnership. This article discusses this workgroup's role in advancing health justice by providing a community-based mental health intervention to marginalized communities in Southern California while using an antiracist praxis tool to develop a successful community-institutional partnership and to live up to the vision of community-based participatory research.

La potencia de los espacios colectivos como estrategia frente a la vulneración de derechos / O poder dos espaços coletivos como estratégia contra a violação de direitos / The power of collective spaces as a strategy against the violation of rights

Resumen Se propone desarrollar la articulación entre los aportes teórico-metodológicos de la terapia ocupacional social y la experiencia de los proyectos Timbó em Movimento y ResisTO, dentro del núcleo de la Rede Metuia perteneciente a la Universidad Federal de Paraíba, Brasil. Se reconoce la importancia de las prácticas territoriales y del campo de la terapia ocupacional social para el fortalecimiento y acompañamiento a poblaciones con diversas condiciones de vulnerabilidad. Se articula lo observado en los proyectos Timbó em Movimento y ResisTO con conceptos como la interseccionalidad de los marcadores sociales de diferencia, sus implicancias en el derecho a la ciudad y sus efectos en el cotidiano de los jóvenes. Se desarrolla la implicancia de los marcadores sociales en los cotidianos de les participantes, así como el potencial de los espacios colectivos de referencia y la articulación intersectorial para enfrentar las violencias. Se concluye que los espacios de pertenencia poseen gran relevancia para el abordaje de conflictos en el campo social, potenciando la participación de les sujetes y el ejercicio de ciudadanía, rechazando la tendencia de buscar soluciones individuales a problemáticas colectivas. Se identifica el desafío de llevar estos diálogos a los contextos cotidianos en que las violencias tienen lugar, incorporando actores que también puedan estar involucrados en su reproducción.

Resumo Propõe-se desenvolver a articulação entre as contribuições teórico-metodológicas da terapia ocupacional social e a experiência dos projetos Timbó em Movimento e ResisTO, dentro do núcleo da Rede Metuia pertencente à Universidade Federal da Paraíba, Brasil. Reconhece-se a importância das práticas territoriais e do campo da terapia ocupacional social para o fortalecimento e acompanhamento de populações com diversas condições de vulnerabilidade. Articula-se a prática dos projetos Timbó em Movimento e ResisTO com conceitos como a interseccionalidade dos marcadores sociais da diferença, suas implicações para o direito à cidade e seus efeitos no cotidiano dos jovens. Desenvolve-se a implicação dos marcadores sociais nos cotidianos dos participantes, assim como o potencial dos espaços coletivos de referência e a articulação intersetorial para o enfrentamento das violências. Conclui-se que os espaços de pertencimento têm grande relevância para o enfrentamento de conflitos no campo social, promovendo a participação dos sujeitos e o exercício da cidadania, rejeitando a tendência de buscar soluções individuais para problemas coletivos. Identifica-se o desafio de levar esses diálogos aos contextos cotidianos em que as violências ocorrem, incorporando atores que também podem estar envolvidos em sua reprodução.

Abstract This paper articulates the theoretical-methodological contributions of social occupational therapy and the experience of "Timbó em Movimento'' and "ResisTO" projects, which are part of the Rede Metuia nucleus belonging to the Federal University of Paraíba (UFPB), Brazil. It recognizes the importance of territorial practices and the social occupational therapy field for the strengthening and support of populations with diverse conditions of vulnerability. Articulation of what was observed in the Timbó em Movimento and ResisTO projects with concepts such as the intersectionality of social markers of difference, their implications for the right to the city and their effects in the daily life of youths. The article elaborates the implications of social markers in the daily life of the participants, as well as the potential of collective reference spaces and intersectoral articulation to confront violence. It is concluded that the spaces of belonging have great relevance for addressing conflicts in the social field, promoting the participation of people and the exercise of citizenship, rejecting the tendency to seek individual solutions to collective problems. Remains the challenge of taking these dialogues to the daily contexts in which violence takes place, incorporating actors that may also be involved in its reproduction.

Voicing student recovery: Embracing diversity in collegiate recovery programs.

Objective: To discuss the engagement of patients and stakeholders (ie, faculty, staff, healthcare providers, and university administrators) in capacity building activities to prepare for future patient-centered research on collegiate recovery. Participants: 502 attended capacity building activities and provided input on priorities for future research in collegiate recovery and 77 participated in the deliberative democracy forum process. Methods: We used surveys and the deliberative democracy forum method, which includes framing sessions and forums for data collection. This method enables individuals with diverse backgrounds to share and learn about differing viewpoints to build consensus for decision making. Results: Forum participants prioritized barriers to recovery for future research and discussed the need to address diversity in collegiate recovery programs, including racial/ethnic diversity in the student recovery population and diversity in pathways to recovery, to decrease barriers to recovery. Conclusions: Institutional support for research on collegiate recovery is critical to move the field forward.

Perceptions of the Coronavirus and COVID-19 testing and vaccination in Latinx and Indigenous Mexican immigrant communities in the Eastern Coachella Valley.

BACKGROUND: A novel coronavirus, SARS-CoV-2 (known as COVID-19), spread rapidly around the world, affecting all and creating an ongoing global pandemic. Across the United States, Latinx and Indigenous populations have been disproportionately affected by COVID-19 cases and death rates. An examination of the perceptions and beliefs about the spread of the virus, COVID-19 testing, and vaccination amongst racial-ethnic minority groups, specifically Latinx and Indigenous Latin American immigrant communities, is needed to alleviate the widespread disparity in new cases and deaths. METHODS: This study was carried out from August 2020 to January 2021 and used community-based participatory research to engage community partners and build the capacity of community health workers (i.e., promotores de salud) and pre-medical and medical students in conducting qualitative research. The objective of the study was to examine the structural and social determinants of health on perceptions of the coronavirus, its spread, and decisions around COVID-19 testing and vaccination. Data collection included ethnography involving observations in public settings and focus groups with members of Latinx and Indigenous Mexican farm-working communities in the Eastern Coachella Valley, located in the Inland Southern California desert region. A total of seven focus groups, six in Spanish and one in Purépecha, with a total of 55 participants were conducted. Topics covered include perceptions of the coronavirus and its spread, as well as COVID-19 testing and vaccination. RESULTS: Using theme identification techniques, the findings identify structural and social factors that underly perceptions held by Latinx and Indigenous Mexican immigrants about the virus and COVID-19, which, in turn, shape attitudes and behaviors related to COVID-19 testing and vaccination. Common themes that emerged across focus groups include misinformation, lack of trust in institutions, and insecurity around employment and residency. CONCLUSIONS: This immigrant population is structurally vulnerable to historical and present-day inequalities that put them at increased risk of COVID-19 exposure, morbidity, and mortality. Study findings indicate a significant need for interventions that decrease structural vulnerabilities by addressing issues of (dis)trust in government and public health among this population.

Personal Freedom and Social Responsibility in Slowing the Spread of COVID-19: A Rapid Qualitative Study.

This rapid qualitative exploratory study focused on perceptions of adopting risk-reduction measures, such as face masks, on campuses within institutions of higher education in the United States. It was intended to identify safety measures to reduce virus spread and develop community-informed public health messaging to promote COVID-19 risk-reduction strategies within campus communities. This study was approved by the institutional review board where the study took place. A total of 113 stakeholders, including students, staff, and faculty attended one of nine focus groups. We use the socioecological model to illustrate the use of COVID-19 public health measures in private and public spaces and how macro-level processes, specifically sociocultural values of personal freedom and social responsibility shape the meaning and interpretation of COVID-19 public health measures. A rapid qualitative data analysis was conducted. This analysis was characterized by three steps: (1) transcription of the interviews, (2) completion of a summary template per focus group analysis (data reduction strategy), and (3) matrix analyses involving a cross-case analysis of the nine focus groups conducted. Based on study findings, we offer community-centered recommendations for safe and healthy reopening of large public research institutions. This article contributes to the foundation of scientific literature that qualitatively describes evidence-based strategies for safe reopening of places of education and employment in the COVID-19 pandemic.

COVID-19 Testing and Vaccine Hesitancy in Latinx Farm-Working Communities in The Eastern Coachella Valley.

Background: A novel coronavirus, SARS-CoV-2 (known as COVID-19), spread rapidly around the world, affecting all and creating an ongoing global pandemic. In the United States, Latinx, African American, and Indigenous populations across the country have been disproportionately affected by COVID-19 cases and death rates. An examination of the perceptions and beliefs about the spread of the virus, COVID-19 testing, and vaccination amongst racial/ethnic minority groups is needed in order to alleviate the widespread disparity in new cases and deaths. Methods: From November to December 2020 the research team conducted focus groups with members of Latinx farm-working communities in the Eastern Coachella Valley, located in the inland southern California desert region. A total of seven focus groups, six in Spanish and one in Purepecha, with a total of 55 participants were conducted. Topics covered include knowledge of the coronavirus, COVID-19 testing and vaccination. Results: Using theme identification techniques, the findings identify structural factors that underly perceptions held by immigrant, migrant, and indigenous Latinx community members about COVID-19, which, in turn, shape attitudes and behaviors related to COVID-19 testing and vaccination. Common themes that emerged across focus groups include misinformation, lack of trust in institutions, and insecurity around employment and residency. Conclusions: This racial/ethnic minority population is structurally vulnerable to historical and present-day inequalities that put them at increased risk of COVID-19 exposure, morbidity, and mortality. Findings from the focus groups indicate a significant need for interventions that decrease structural vulnerabilities by addressing issues of (dis)trust in government and public health among this population.

Engaging Stakeholders in the Healthy Campus Movement.

BACKGROUND: Institutions of higher education are increasingly attending to the health of their campus community. This article reports on a Healthy Campus Initiative (HCI) to build a culture of health. OBJECTIVES: Evaluate the applicability of the four action areas of the Robert Wood Johnson Foundation Culture of Health Framework to campus health and discuss challenges and lessons learned. METHODS: Observational, qualitative, and quantitative data were collected to describe partnership development, key stakeholder engagement, and stakeholder perceptions of healthy campus activity between 2016 and fall 2018. RESULTS: This initiative aligned with 3 of the four action areas of the Culture of Health Framework by making campus health as a shared value, fostering campus and local community collaborations, and creating a healthier and more equitable campus community. CONCLUSIONS: For institutions of higher education, the Culture of Health Framework is ideal to engage stakeholders to take action to create and build cultures of health.

Identificación y prevención de riesgos de origen químico en centros laborales de Santiago de Cuba / Prevention and identification of chemical originated risks in workcenters in Santiago, Cuba

En el Servicio de Salud Ocupacional de TOXIMED, nos propusimos identificar los riesgos químicos presentes y analizar su interrelación con las condiciones de trabajo en once centros laborales. Se obtuvo información de la composición química de las sustancias, sus usos, peligrosidad y toxicidad, tiempo de exposición, la exposición directa e indirecta a las sustancias químicas, la protección personal, la higiene laboral, la presencia de ventilación natural o artificial y otras características técnicas del proceso productivo. Predominaron los hidrocarburos, los metales, los ácidos, y las sustancias básicas, hallándose un uso erróneo generalizado de derivados del petróleo. Se encontraron sustancias carcinogénicas, tóxicas por inhalación, corrosivas, irritantes, oxidantes, inflamables y una mutagénica. Con respecto a las condiciones laborales hubo una supremacía en la ausencia del equipamiento de protección individual (41.84 por ciento), luego el incumplimiento de las medidas de higiene (28,57por ciento), y por último se presentó el problema de la ventilación y el escape de sustancias químicas (16.32 por ciento). La Asesoría de Riesgo Laboral permitió considerar la peligrosidad de las sustancias empleadas y valorar cualitativamente los riesgos potenciales por puestos de trabajo, no antes valorado en estas entidades con un enfoque toxicológico, y el cumplimiento de las medidas recomendadas para el control de los riesgos estuvieron encaminadas a disminuir el impacto negativo de los riesgos de origen químico en a salud del trabajador.

Lesiones genéticas y citológicas inducidas por la exposición a químicos en centros de trabajo / Cytogenotoxic changes in human buccal epithelial cells and their association with selected occupational exposures to chemical products

Se realizó una investigación con el objetivo de describir las lesiones citogenotóxicas en células bucoepiteliales humanas, asociadas a la exposición de químicos laborales (medicamentos antineoplásicos, polvo de cebada, dióxido de carbono, amoníaco, nafta, mezclas complejas de tolueno, metanol, xileno y cloroetileno y vapores de soldadura) e identificar la relación existente entre frecuencia de aparición de trastornos citotoxicos con edad, antigüedad en el puesto y hábitos tóxicos. Para lograrlo se realizó un estudio descriptivo y transversal, conformado por 31 controles y 88 trabajadores expuestos; a los cuales se le indagó sobre edad, antigüedad, tiempo y tipo de exposición, uso de protección respiratoria y toxicomanías. A las células de la mucosa bucal, se le estimó frecuencia de lesiones genotoxicas (micronúcleos) y citotoxicas (binucleación, picnosis, cromatina condensada y cariolisis). Correlacionado este último indicador con edad, antigüedad y toxicomanías a través del Coeficiente de Pearson. Los resultados indican que el 70.45 por ciento (nn= 62) de los trabajadores no usan protección respiratoria y que el 82.95 por ciento (nn= 73) están expuestos directamente a químicos laborales. Los antineoplásicos promovieron significativamente lesiones citogenotóxicas, mientras que el polvo de cebada y la nafta provocaron alto efecto citotoxico. No existió relación significativa entre citotoxicidad y edad (r= 0.10), antigüedad (r = 0.14), tabaquismo (r = 0.02), y alcoholismo (r = 0.11). Se concluye que los mayores niveles de afectaciones citogenotóxicas correspondieron a la exposición a medicamentos antineoplásicos. La citotoxicidad observada no está correlacionada con la edad, ni con la antigüedad en el puesto de trabajo, ni con presencia de hábitos tóxicos.

[Buccoepithelial cytologic lesions in workers exposed to chemical products]. / Lesiones citológicas bucoepiteliales en trabajadores expuestos a productos quimicos.

OBJECTIVES: Our aim was to describe the genetic and cytologic lesions induced by occupational exposition to chemicals (barley powder, carbon dioxide, ammonia, organic solvents, and welding vapors) and to correlate frequencies of appearance of buccoepithelial cytologic disorders with age and toxic habits. MATERIALS AND METHODS: This descriptive, transverse observational study was comprised of 77 male workers to obtain information concerning age, on-the-job seniority, time of exposure, direct and indirect exposure, use of breathing protection, and toxic habits. We used exfoliated cells of the buccal mucosa to estimate presence of chromosomal aberrations (micronuclei) and nuclear abnormalities (binucleation, pyknosis, condensed chromatin, and karyolysis). Results were correlated by Pearson's coefficient. RESULTS: The investigated workers labored 8 h/ day; 80.5% were exposed directly to chemicals, while 19.5% were indirectly exposed during an average of 6.5 h per workday. A total of 85.7% of workers referred not using breathing protection, and 28.6% and 36.4% reported smoking and alcohol consumption, respectively. In a general manner, we detected a certain prevalence of irreversible cytotoxic lesions and absence of a statistically significant correlation between cytotoxicity and age (r = 0.14), alcohol consumption (r = 0.02) and smoking (r = 0.11).

Asesoría de riesgo laboral: identificación y prevención del riesgo ocupacional / Working risk counselling: identification and prevention of the occupational risk

Con el objetivo de desarrollar el servicio de salud ocupacional del Centro de Toxicología y Biomedicina de Santiago de Cuba, se elaboró un documento (asesoría de riesgo laboral) a partir de la identificación de los principales riesgos laborales y los efectos tóxicos que para la salud estos poseen a corto y a largo plazos, para lo cual se efectuó una búsqueda bibliográfica exhaustiva y una valoración cuantitativa de los riesgos físicos, así como cualitativa de los riesgos químicos, lo que permite establecer una posible asociación de dichos riesgos con el resultado del estudio de salud ocupacional de los trabajadores expuestos. En el presente trabajo se muestran los aspectos informativos de este documento, la metodología de trabajo y las fuentes de información consultadas.

In order to develop the occupational health service of theToxicology and Biomedicine Center of Santiago de Cuba, a document (working risk counselling) was made starting from the identification of the main working risks and their toxic effects for health on the short and long term. To this end, there were made an exhaustive bibliographic search, a quantitative assessment of the physical risks and a qualitative evaluation of the chemical risks that allowed to establish a possible association of these risks with the result of the occupational health study conducted among the exposed workers. The informative aspects of this document, the working methodology and the consulted information sources were shown in the present paper.