Utah Latina/o/x suicide decedents less likely to die by firearm, even in rural areas: examining population-wide data from the Utah Office of the Medical Examiner.

Introduction: Suicide death remains a significantly rarer event among Latina/o/x populations compared to non-Latina/o/x populations. However, the reasons why Latina/o/x communities experience relatively lower suicide rates are not fully understood. Critical gaps exist in the examination of Latina/o/x suicide death, especially in rural settings, where suicide death by firearm is historically more common within non-Latina/o/x populations. Method: We tested whether the prevalence of Latina/o/x firearm suicide was meaningfully different in urban and rural environments and from non-Latino/a/x decedents when controlling for age, sex, and a social deprivation metric, the Area Deprivation Index. Suicide death data used in this analysis encompasses 2,989 suicide decedents ascertained in Utah from 2016 to 2019. This included death certificate data from the Utah Office of the Medical Examiner on all Utah suicide deaths linked to information by staff at the Utah Population Database. Results: Compared to non-Latina/o/x suicide decedents, Latina/o/x suicide decedents had 34.7% lower adjusted odds of dying by firearm. Additionally, among the firearm suicide decedents living only in rural counties, Latina/o/x decedents had 40.5% lower adjusted odds of dying by firearm compared to non-Latina/o/x suicide decedents. Discussion: The likelihood of firearm suicide death in Utah differed by ethnicity, even in rural populations. Our findings may suggest underlying factors contributing to lower firearm suicide rates within Latina/o/x populations, e.g., aversion to firearms or less access to firearms, especially in rural areas, though additional research on these phenomena is needed.

Deconstructing Cultural Aspects of Mental Health Care in Hispanic/Latinx People.

In the United States, 18.9% of the population identifies as Hispanic or Latin. The culture of these communities is as diverse, heterogenous, and rich as the history of this population. Culture shapes the perception of symptoms and psychiatric disorders. To provide culturally sensitive care, it is relevant to understand the history of these communities in the US, recognize cultural humility, and acknowledge aspects and values (eg, culturally bound syndromes, familism, paternalism, stigma of mental illness, machismo, immigration) inherent to the cultural experience and unique barriers to care. Incorporating these aspects into clinical practice is essential for positive outcomes. The purpose of this article is to give a brief historical context, encourage cultural humility, and describe cultural aspects that are essential when providing culturally sensitive care to the Hispanic and Latinx community in the US.

Application of the RE-AIM framework to evaluate the implementation of telehealth pulmonary rehabilitation in a randomized controlled trial among African-American and Hispanic patients with advanced stage Chronic Obstructive Pulmonary Disease.

BACKGROUND: Pulmonary rehabilitation (PR) decreases rehospitalization for people with COPD. However, less than 2% receive PR, partly due to lack of referral and sparsity of PR facilities. This disparity is particularly pronounced in African American and Hispanic persons with COPD. Telehealth-provided PR could increase access and improve health outcomes. METHODS: We applied the RE-AIM framework in a post-hoc analysis of our mixed methods RCT comparing referral to Telehealth-delivered PR (TelePR) versus standard PR (SPR) for African American and Hispanic COPD patients hospitalized for COPD exacerbation. Both arms received a referral to PR for 8 weeks, social worker follow-up, and surveys administered at baseline, 8 weeks, 6, and 12 months. PR sessions were conducted twice a week for 90 min each (16 sessions total). Quantitative data were analyzed using 2-sample t tests or nonparametric Wilcoxon tests for continuous data and χ2/Fisher exact tests for categorical data. Logistic regression-estimated odds ratios (ORs) were used for the intention-to-treat primary outcome. Qualitative interviews were conducted at the end of the study to assess adherence and satisfaction and were analyzed using inductive and deductive methods. The goal was to understand Reach (whether the target population was able to be enrolled), Effectiveness (primary outcome was a composite of 6-month COPD rehospitalization and death), Adoption (proportion of people willing to initiate the program), Implementation (whether the program was able to be executed as intended, and Maintenance (whether the program was continued). RESULTS: Two hundred nine people enrolled out of a 276-recruitment goal. Only 85 completed at least one PR session 57/111 (51%) TelePR; 28/98 (28%) SPR. Referral to TelePR compared to SPR did not decrease the composite outcome of 6-month COPD-readmission rate/death (OR1.35;95%CI 0.69,2.66). There was significant reduction in fatigue (PROMIS® scale) from baseline to 8-weeks in TelePR compared to SPR (MD-1.34; ± SD4.22; p = 0.02). Participants who received TelePR experienced improvements from baseline in several outcomes (ie, before and after 8 weeks of PR) in the following: COPD symptoms, knowledge about COPD management, fatigue, and functional capacity. Among the patients who had 1 initial visit, adherence rates were similar (TelePR arm, 59% of sessions; SPR arm, 63%). No intervention-related adverse events occurred. Barriers to PR adoption included difficulty or reluctance to complete medical clearances and beliefs about PR efficacy. Notably, only 9 participants sustained exercise after program completion. Maintenance of the program was not possible due to low insurance reimbursement and sparsity of Respiratory Therapists. CONCLUSIONS: TelePR can reach COPD patients with health disparities and can be successfully implemented. The small sample size and large confidence intervals prevent conclusion about the relative effectiveness of participating in TelePR compared to SPR. However, improved outcomes were seen for those in TelePR as well as in SPR. Increasing adoption of PR and TelePR requires consideration of comorbidity burden, and perception of PR utility, and must facilitate medical clearances. Given the sparsity of SPR locations, TelePR can overcome at least the barrier of access. However, given the challenges to the uptake and completion of PR - many of the additional barriers in PR (both in TelePR and SPR) need to be addressed. Awareness of these real-world challenges will not only inform implementation of TelePR for clinicians seeking to adopt this platform but will also inform study designers and reviewers regarding the feasibility of approaches to patient recruitment and retention.

Evidence of transgenerational effects on autism spectrum disorder using multigenerational space-time cluster detection.

BACKGROUND: Transgenerational epigenetic risks associated with complex health outcomes, such as autism spectrum disorder (ASD), have attracted increasing attention. Transgenerational environmental risk exposures with potential for epigenetic effects can be effectively identified using space-time clustering. Specifically applied to ancestors of individuals with disease outcomes, space-time clustering characterized for vulnerable developmental stages of growth can provide a measure of relative risk for disease outcomes in descendants. OBJECTIVES: (1) Identify space-time clusters of ancestors with a descendent with a clinical ASD diagnosis and matched controls. (2) Identify developmental windows of ancestors with the highest relative risk for ASD in descendants. (3) Identify how the relative risk may vary through the maternal or paternal line. METHODS: Family pedigrees linked to residential locations of ASD cases in Utah have been used to identify space-time clusters of ancestors. Control family pedigrees of none-cases based on age and sex have been matched to cases 2:1. The data have been categorized by maternal or paternal lineage at birth, childhood, and adolescence. A total of 3957 children, both parents, and maternal and paternal grandparents were identified. Bernoulli space-time binomial relative risk (RR) scan statistic was used to identify clusters. Monte Carlo simulation was used for statistical significance testing. RESULTS: Twenty statistically significant clusters were identified. Thirteen increased RR (> 1.0) space-time clusters were identified from the maternal and paternal lines at a p-value < 0.05. The paternal grandparents carry the greatest RR (2.86-2.96) during birth and childhood in the 1950's-1960, which represent the smallest size clusters, and occur in urban areas. Additionally, seven statistically significant clusters with RR < 1 were relatively large in area, covering more rural areas of the state. CONCLUSION: This study has identified statistically significant space-time clusters during critical developmental windows that are associated with ASD risk in descendants. The geographic space and time clusters family pedigrees with over 3 + generations, which we refer to as a person's geographic legacy, is a powerful tool for studying transgenerational effects that may be epigenetic in nature. Our novel use of space-time clustering can be applied to any disease where family pedigree data is available.

Spatial Distribution of Hateful Tweets Against Asians and Asian Americans During the COVID-19 Pandemic, November 2019 to May 2020.

Objectives. To illustrate the spatiotemporal distribution of geolocated tweets that contain anti-Asian hate language in the contiguous United States during the early phase of the COVID-19 pandemic. Methods. We used a data set of geolocated tweets that match with keywords reflecting COVID-19 and anti-Asian hate and identified geographical clusters using the space-time scan statistic with Bernoulli model. Results. Anti-Asian hate language surged between January and March 2020. We found clusters of hate across the contiguous United States. The strongest cluster consisted of a single county (Ross County, Ohio), where the proportion of hateful tweets was 312.13 times higher than for the rest of the country. Conclusions. Anti-Asian hate on Twitter exhibits a significantly clustered spatiotemporal distribution. Clusters vary in size, duration, strength, and location and are scattered across the entire contiguous United States. Public Health Implications. Our results can inform decision-makers in public health and safety for allocating resources for place-based preparedness and response for pandemic-induced racism as a public health threat. (Am J Public Health. 2022;112(4):646-649. https://doi.org/10.2105/AJPH.2021.306653.

Status Migrainosus and Endometriosis: A Case Report and Review of the Literature.

Status migrainosus is a migraine complication describing an attack lasting longer than 72 hours. In this paper, we present a case of a 34-year-old female with a history of severe endometriosis and hypercoagulable factor type II disease who presented to the emergency department (ED) with a three-week history of new-onset intractable migraine with aura. Imaging findings revealed a frontal T2/FLAIR hyperintensity, venous anomaly, and bilateral optic nerve thickening. The patient was admitted for three days of inpatient treatment with improvement of her symptoms.

Ending the HIV epidemic using National HIV Behavioral Surveillance (NHBS): Recommendations based on DC model.

INTRODUCTION: Social network strategies have been used by health departments to identify undiagnosed cases of HIV. Heterosexual cycle (HET4) of National HIV Behavioral Surveillance (NHBS) is a social network strategy implemented in jurisdictions. The main objectives of this research are to 1) evaluate the utility of the NHBS HET cycle data for network analysis; 2) to apply statistical analysis in support of previous HIV research, as well as to develop new research results focused on demographic variables and prevention/intervention with respect to heterosexual HIV risk; and 3) to employ NHBS data to inform policy with respect to the EHE plan. METHOD: We used data from the 2016 NHBS HET4 (DC). A total of 747 surveys were collected. We used the free social-network analysis package, GEPHI, for all network visualization using adjacency matrix representation. We additionally conducted logistic regression analysis to examine the association of selected variables with HIV status in three models representing 1) demographic and economic effects, 2) behavioral effects, and 3) prevention-intervention effects. RESULTS: The results showed 3% were tested positive. Seed 1 initiated the largest networks with 426 nodes (15 positives); seed 4 with 273 nodes (6 positives). Seed 3 had 35 nodes (2 positives). All 23 HIV diagnoses were recruited from 4 zip-codes across DC. The risk of testing positive was higher among people high-school dropouts (Relative Risk (RR) (25.645); 95 CI% 5.699, 115.987), unemployed ((4.267); 1.295, 14.064), returning citizens ((14.319); 4.593, 44.645). We also found in the final model higher association of pre-exposure prophylaxis (PrEP) awareness among those tested negative ((4.783); 1.042, 21.944) and HIV intervention in the past 12 months with those tested positive ((17.887); 2.350,136.135). CONCLUSION: The network visualization was used to address the primary aim of the analysis-evaluate the success of the implementation of the NHBS as a social network strategy to find new diagnoses. NHBS remains one of the strongest behavioral supplements for DC's HIV planning activities. As part of the evaluation process our analysis helps to understand the impact of demographic, behavioral, and prevention efforts on peoples' HIV status. We strongly recommend other jurisdictions use network visualizations to evaluate the efficacy in reaching hidden populations.

Reflections on hateful responses to research on hate in the United States.

While researching hate and gaining media attention beginning in 2018, we incurred a good amount of hate toward us and our research in the form of online comments and direct correspondence. Rather than just pass the comments off as general hate, we collected the text and analyzed it in an attempt to better understand the beliefs, perceptions, and arguments of those that rejected our efforts toward gaining knowledge on geographical hate trends. We use content analysis to identify categories of anti-hate research argumentation based on the comments. A discussion is provided on the implications of our findings and insight from our experiences is given.

A Telehealth-Delivered Pulmonary Rehabilitation Intervention in Underserved Hispanic and African American Patients With Chronic Obstructive Pulmonary Disease: A Community-Based Participatory Research Approach.

BACKGROUND: Although home telemonitoring (TM) is a promising approach for patients managing their chronic disease, rehabilitation using home TM has not been tested for use with individuals living with chronic obstructive pulmonary disease (COPD) residing in underserved communities. OBJECTIVE: This study aimed to analyze qualitative data from focus groups with key stakeholders to ensure the acceptability and usability of the TM COPD intervention. METHODS: We utilized a community-based participatory research (CBPR) approach to adapt a home TM COPD intervention to facilitate acceptability and feasibility in low-income African American and Hispanic patients. The study engaged community stakeholders in the process of modifying the intervention in the context of 2 community advisory board meetings. Discussions were audio recorded and professionally transcribed and lasted approximately 2 hours each. Structural coding was used to mark responses to topical questions in interview guides. RESULTS: We describe herein the formative process of a CBPR study aimed at optimizing telehealth utilization among African American and Latino patients with COPD from underserved communities. A total of 5 major themes emerged from qualitative analyses of community discussions: equipment changes, recruitment process, study logistics, self-efficacy, and access. The identification of themes was instrumental in understanding the concerns of patients and other stakeholders in adapting the pulmonary rehabilitation (PR) home intervention for acceptability for patients with COPD from underserved communities. CONCLUSIONS: These findings identify important adaptation recommendations from the stakeholder perspective that should be considered when implementing in-home PR via TM for underserved COPD patients. TRIAL REGISTRATION: ClinicalTrials.gov NCT03007485; https://clinicaltrials.gov/ct2/show/NCT03007485.

Impact of Zika Virus on adult human brain structure and functional organization.

OBJECTIVE: To determine the impact of Zika virus (ZIKV) infection on brain structure and functional organization of severely affected adult patients with neurological complications that extend beyond Guillain-Barré Syndrome (GBS)-like manifestations and include symptoms of the central nervous system (CNS). METHODS: In this first case-control neuroimaging study, we obtained structural and functional magnetic resonance images in nine rare adult patients in the subacute phase, and healthy age- and sex-matched controls. ZIKV patients showed atypical descending and rapidly progressing peripheral nervous system (PNS) manifestations, and importantly, additional CNS presentations such as perceptual deficits. Voxel-based morphometry was utilized to evaluate gray matter volume, and resting state functional connectivity and Network Based Statistics were applied to assess the functional organization of the brain. RESULTS: Gray matter volume was decreased bilaterally in motor areas (supplementary motor cortex, specifically Frontal Eye Fields) and beyond (left inferior frontal sulcus). Additionally, gray matter volume increased in right middle frontal gyrus. Functional connectivity increased in a widespread network within and across temporal lobes. INTERPRETATION: We provide preliminary evidence for a link between ZIKV neurological complications and changes in adult human brain structure and functional organization, comprising both motor-related regions potentially secondary to prolonged PNS weakness, and nonsomatomotor regions indicative of PNS-independent alternations. The latter included the temporal lobes, particularly vulnerable in a range of neurological conditions. While future studies into the ZIKV-related neuroinflammatory mechanisms in adults are urgently needed, this study indicates that ZIKV infection can lead to an impact on the brain.

Changes in gray and white matter in subgroups within the tinnitus population.

In this study, we investigated gray and white matter changes in subgroups within the larger tinnitus population related to differences in severity or duration of tinnitus symptoms. Tinnitus is the illusory perception of sound in the absence of an external source, most often experienced as a chronic condition. The psychological reaction to the sound constitutes the severity, or degree of discomfort experienced, and the duration refers to the time since onset of chronic tinnitus. We used voxel- and surface-based morphometry to investigate gray matter changes and diffusion tensor imaging (using fractional anisotropy, or FA, metrics) to assess changes in orientation of white matter tracts, using both whole brain and region of interest analyses. Whole brain analyses revealed decreased cortical thickness in the left parahippocampal gyrus in those with more severe tinnitus compared to a group with a milder reaction, and reduced gray matter volume in left anterior cingulate in those with mild tinnitus compared to a normal hearing control group without tinnitus. In the analysis based on FA, no significant differences were revealed between the subgroups or with respect to control groups in either whole brain or region of interest analyses. Our results suggest that these subgroups within the tinnitus population likely exhibit different anatomical alterations related to the disorder, which may explain the variable findings in the literature, particularly in terms of gray matter.

Opinión sobre el reporte de enfermería en enfermeros del Servicio de Emergencia del Hospital San Juan de Lurigancho, diciembre 2015 / Opinion about the nursing report in the nurses of the Emergency Service at the Hospital San Juan de Lurigancho, December 2015

El profesional de enfermería durante su labor diaria hace uso del registro de enfermería, el cual es elaborado mediante el uso de algunas técnicas de recolección de datos, como el reporte de enfermería que es el tiempo que emplea la enfermera (o) al finalizar el turno para dar informe a la enfermera del turno siguiente sobre el servicio, la situación de los pacientes y su evolución, así como del personal, patrimonio y otra eventualidad. Pero al buscar la causa del problema en algunas instituciones de salud, los enfermeros refieren sobre el reporte de enfermería: "Solo se reporta lo básico, a veces así se hace por la cantidad de pacientes que se atiende", "muchas veces el personal reporta cosas insignificantes", en este contexto se decide investigar: ¿Cuál es la Opinión sobre el Reporte de Enfermería en Enfermeros del Servicio de Emergencia del Hospital San Juan de Lurigancho, diciembre 2015? Siendo el objetivo determinar la Opinión de los Enfermeros sobre EL Reporte de Enfermería en el Servicio de Emergencia del Hospital de San Juan de Lurigancho, se utilizó el método descriptivo, de corte transversal, población de 30 enfermeras, la técnica fue la encuesta y el instrumento el cuestionario, los resultados hallados en este estudio fueron: "La Opinión que posee los Enfermeros sobre el Reporte de Enfermería, de un total de 30 (100 por ciento) Enfermeras(o), 22 (73 por ciento) tienen una Opinión Favorable, 8 (27 por ciento) tienen una Opinión Medianamente Favorable y finalmente 0 (0 por ciento) tienen una Opinión Desfavorable. Por lo que se concluye que en el Servicio de Emergencia del HSJL los Enfermeros, tienen opinión medianamente favorable sobre el Reporte de enfermería, lo que podría indicar consecuencias de falta de un reporte ideal que influye negativamente en el desarrollo de las actividades y del desempeño del personal de enfermería durante la entrega de turno, además en consecuencia con la continuidad del cuidado del paciente.

Professional nursing during their daily work makes use of the nursing record, which is produced through the use of some techniques of data collection, as the report of nursing which is the time that the nurse uses (or) at the end of the round to give report to the nurse the next turn on the service, the status of patients and its evolution, as well as of staff, heritage and another eventuality. But to find the cause of the problem in some health institutions, the nurses concerned about nursing report: "only reports the basics, at times so it is made by the number of patients served," "many times staff reports insignificant things," in this context is decides to investigate what is the Opinion of nurses on the report nursing in the service of emergency of the Hospital San Juan de Lurigancho December 2015? The objective being to determine the Opinion of nurses on nursing report in the service of emergency of the Hospital of San Juan de Lurigancho, descriptive, cross-sectional, population of 30 nurses method is used, the technique was the survey and instrument the questionnaire, the results found in this study were: "the Opinion that holds the nurse on nursing report, a total of 30 (100 per cent) Nurses, 22 (73 per cent) have a Favorable Opinion, 8 (27 per cent) have a fairly positive Opinion and finally 0 (0 per cent) have an unfavorable Opinion. What is concluded in the HSJL nurse's emergency service, have moderately favorable opinion on nursing report, which could indicate the consequences of lack of an ideal reporting negatively influencing the development of the activities and performance of nurses during the delivery of the day, also in consequence with the continuity of care of the patient.

Visualizing diurnal population change in urban areas for emergency management.

There is an increasing need for a quick, simple method to represent diurnal population change in metropolitan areas for effective emergency management and risk analysis. Many geographic studies rely on decennial U.S. Census data that assume that urban populations are static in space and time. This has obvious limitations in the context of dynamic geographic problems. The U.S. Department of Transportation publishes population data at the transportation analysis zone level in fifteen-minute increments. This level of spatial and temporal detail allows for improved dynamic population modeling. This article presents a methodology for visualizing and analyzing diurnal population change for metropolitan areas based on this readily available data. Areal interpolation within a geographic information system is used to create twenty-four (one per hour) population surfaces for the larger metropolitan area of Salt Lake County, Utah. The resulting surfaces represent diurnal population change for an average workday and are easily combined to produce an animation that illustrates population dynamics throughout the day. A case study of using the method to visualize population distributions in an emergency management context is provided using two scenarios: a chemical release and a dirty bomb in Salt Lake County. This methodology can be used to address a wide variety of problems in emergency management.

Pancreatitis por Leptospira: A propósito de un caso

Se presenta un caso de un paciente masculino de 32 años quien acude a la emergencia del hospital DOMINDO GUZMAN LANDER DE BARCELONA, que consulta por dolor abdominal de fuerte intensidad, malestar general y fiebre de 39 ºC de una semana de evolución y afectación del estado general, se practican clínicos y paraclinicos, los cuales reportan: perfil lipidito dentro limites normales, enzimas pancreáticas y serologia IGm (+) para Leptospira, ecosonograma. TAC abdominal y RM, sin patologías de vías biliares. Se inicio tratamiento con PNC y medidas generales, presentando evolución satisfactoria. La pancreatitis es un proceso inflamatorio agudo, desarrollado sobre una glándula pancreática sana, que se caracteriza por elevación de los niveles de enzimas pancreáticas en sangre y orina, que puede ocasionar fallas orgánicas o complicaciones locales. Leptospirosis una zoonosis que se produce por contacto de tejido animal, liquido excretado o aguas contaminadas con periodo de incubación de 7 - 14 días, con manifestaciones clínicas sistémicas que puede evolucionar a formas graves ; insuficiencia hepática - renal o colapso vascular. Se presenta el siguiente caso de pancreatitis por lo inusual de su de su etiología.

A case is presented of a 32 years old masculine patient who attends the emergency room of the Hospital DOMINDO GUZMAN LANDER OF BARCELONA, referring intense abdominal pain, general malaise and fever of 39 cº of one week of evolution and affectation of the general state, clinical and Para clinical test are done, which report: lipid profile within normal values, pancreatic enzymes and serum IGm (+) for Leptospira, abdominal ultrasound, CT Scan and MRI, without biliary tract abnormalities. Treatment with PNC was started and general measures, presenting a satisfactory evolution. Pancreatitis is an acute inflammatory process, developed on a healthy pancreatic gland that is characterized by elevation of the pancreatic enzyme levels in blood and urine, which can cause organic failure or local complications. Leptospirosis a zoonosis caused by exposure to animal tissue, secreted liquids or contaminated waters with an incubation period of 7 -14 days, with systemic clinical manifestations that can evolve to serious forms; hepatic-renal insufficiency or vascular collapse. The pancreatitis case that follows is presented regarding its unusual ethiology.