Promotoras Voice Their Challenges in Fulfilling Their Role as Community Health Workers.

Promotoras de salud (Spanish for female community health workers) are integral to efforts to enhance the health and well-being of Latinx individuals, families, and communities. The purpose of this study was to describe the challenges that promotoras face and the proposed solutions from the perspective of the promotoras themselves. Five promotoras who worked for a year as volunteers in a community-based participatory research study, Lazos Hispanos, participated in two group interviews. Eight challenges emerged-balancing their new work with their family commitments, handling their perceived imbalance of power with men, managing the emotional impact of hearing participants' problems, facing and handling the barriers imposed by having limited English language skills, feeling discouraged by the perception of ethnocentric beliefs and discrimination from some providers, feeling disheartened by the cultural beliefs of some Latinx participants, handling the lack of transportation for themselves and for the participants, and managing the burden of data collection for the research aspect of the program. The explanation of these challenges and the practical solutions they proposed are embedded in their intersecting identities. The solutions are a valuable addition to the practice of health promotion and community-based participatory research, particularly within Latinx communities.

Overcoming Barriers: Practical Strategies to Assess Latinos Living in Low-Income Communities.

The value of community assessments depends on the researchers' ability to reach a diverse and representative sample of participants. This process is particularly challenging when assessing the health and well-being of vulnerable populations that are reticent to participate in research because of demographic and sociopolitical factors. One such group is Latinxs (the gender-neutral version of Latinos or Latinas) of mixed immigration status who live in low-income, socially and geographically isolated enclaves in the Southeast. Framed by community-based participatory research and social marketing theories, this study describes practical strategies for health researchers, practitioners, and advocates seeking to engage and build trusting relationship within U.S. Latinx communities. First, identify and leverage points of entry to different segments of the communities of interest by engaging meaningful gatekeepers from different sections of the population and searching for places where potential participants gather. Second, reduce the burden of assessments by using incentives and creating intentional reciprocity. Third, establish critical, long-lasting trust with community members, leaders, and allies by adapting data collection procedures, ensuring confidentiality, engaging bilingual facilitators, and most important, being present with and for the community. Finally, presenting the findings back to the community can increase the ownership of the process.

A multistakeholder evaluation of Lazos Hispanos: An application of a community-based participatory research conceptual model.

The goal of Lazos Hispanos is to enhance the health and well-being of the Latinx community through promotoras, who connect community members with service providers for multiple health and social needs. A community-based participatory research conceptual model framed the multimethod evaluation of promotoras, service providers, and community participants at baseline and at the 1-year follow up. The promotoras increased their self-efficacy and knowledge, felt a strong sense of commitment to the community, viewed themselves as a bridge between participants and providers, and felt empowered by their new role. Service providers valued the promotoras as their ambassadors in the community and Lazos Hispanos as central to connecting service providers, promotoras, and community members; they noted that this collaboration increased their accountability with the Latinx community. This multistakeholder evaluation highlights the depth of positive changes achieved during the first year and the challenges of a community-embedded project and the benefits and possibilities of calling upon theoretically informed evaluation models.

Lazos Hispanos: Promising Strategies and Lessons Learned in the Development of a Multisystem, Community-Based Promotoras Program.

U.S. Latinos face multiple inter-related barriers to access health and social services. Researchers and practitioners have called upon community-based participatory research (CBPR) to address such challenges and health disparities, with the community health worker-or promotoras-model evidencing positive outcomes. What is less clear, however, are the promising strategies to support the development of a multisystem, community-based promotoras program. In response, the current study applied a CBPR conceptual model as an organizing framework to develop a promotora program. Lazos Hispanos (Hispanic Links) was developed to enhance the health and well-being of Latinx residing in low-income communities in the Southeastern United States. This study highlights 16 lessons learned, anchored in the first two dimensions of the CBPR conceptual model: community context and partnership development. First, the community assessment and activities leading to Lazos Hispanos took nearly 2 years but were crucial to develop a strong basis for the program. Second, the development of a multicultural and interdisciplinary research team enriched every aspect of the program and enhanced culturally responsive community engagement. Selection, training, and ongoing support of the promotoras were fundamental to program success. Particularly important were the following: receiving mentorship from a successful promotora organization; delineating mutually agreed upon roles and responsibilities; following national training standards for community health workers; and, holding monthly meetings for training, support, and data collection. The engagement of community service providers as partners was facilitated by building upon existing community relationships, signing a memorandum of understanding that specified roles and responsibilities, conducting tours of provider facilities with the promotoras, and keeping providers abreast of the program via bi-annual community gatherings. The development process showed fidelity to the conceptual model. Lazos Hispanos has proven an asset to participants, the promotoras, and service providers as the program continues to develop a community-based, health supportive infrastructure.

Protocolo de manejo en mordeduras por animales: revisión de la literatura e informe de casos / A protocol for the management of animal bites: a review of the literature and report of cases

Las mordeduras por animales son heridas complicadas. Estas lesiones pueden ser macerantes, punzantes, lacerantes o avulsivas. Es imprescindible la profilaxis antibiótica, antitetánica y antirrábica. El aspecto más importante es la limpieza de la herida y el ulterior cierre primario de la misma. El manejo postquirúrgico incluye un control estrecho para prevenir o controlar la infección y la revisión secundaria de la cicatriz para reconstrucción, en caso necesario.

Animal bites are complicated wounds. They may consist of crush, punctures, lacerations or avulsions lesions. Antibiotic, tetanus and rabies prophylaxis is indispensable. The most important principle is wound cleansing and subsequent lacerations primary closure. Postoperative management includes close observation to avoid or control infection and secondary scar revision for reconstruction, if necessary.

Reemplazo temporomandibular. ¿Autógeno o aloplástico?: revisión de la literatura / Temporomandibular replacement. Autogenous or alloplastic?: a review of the literature

En algunos casos la patología articular produce la destrucción estructural, por lo que el reemplazo de los componentes de la articulación temporomandibular (ATM) es necesario. Las técnicas quirúrgicas pueden consistir en el reemplazo del cóndilo, la cavidad glenoidea y su eminencia articular, o ambos elementos. En los pacientes en crecimiento con asimetría deben emplearse los injertos costocondrales. La reconstrucción aloplástica es útil en pacientes adultos que han sido sometidos a múltiples operaciones en las que los injertos autógenos han fracasado.

In some cases joint pathology produces the destruction of structures so that replacement of components of temporomandibular joint (TMJ) is necessary. Surgical techniques may consist in replacement of the condyle, fossa components, or both elements. In growing individuals with asymmetry, costochondral grafts should be used. The alloplastic reconstruction is specially useful in adult patients who have undergone multiple operations in which autogenous grafts have failed.

Anquilosis temporomandibular. Revisión de la literatura: protocolo de manejo e informe de un caso / Temporomandibular ankylosis. A review of the literature: management protocol and report of a case

La anquilosis de la articulación temporomandibular (ATM) es una complicación seria, principalmente posterior a traumatismos e infecciones locales o sistémicas. Las causas infecciosas desaparecieron tempranamente con la aparición de los antibióticos. En casos raros la anquilosis de ATM se asocia a enfermedades sistémicas como la espondilitis anquilosante, artritis reumatoide y psoriasis. De acuerdo a las restricciones funcionales y las alteraciones provocadas en el crecimiento facial en la juventud, es deseable una terapia temprana y efectiva. Hay diversas maneras de manejar la anquilosis de la ATM que van desde el empleo de injertos osteocondrales hasta la colocación de prótesis. No existe un concepto quirúrgico estandarizado, pero todos están en función de la cooperación y disciplina que el paciente observe en la fisioterapia postquirúrgica.

Ankylosis of the temporomandibular joint (TMJ) is a serious complication, mainly after trauma and local or systemic infection. The infection cause has nearly disappeared in the era of antibiotics. In rare cases ankylosis is associated with systemic disease such ankylosing spondylitis, rheumatoid arthritis and psoriasis. According to the functional restriction and the provoked disturbances of facial growth in the youth, an early and effective therapy is desirable. There are a wide variety of surgical approaches to TMJ ankylosis, ranging from chondro-osseous grafts to prosthesis. One stdandard surgical concept does not exist, but all surgical concepts are as good as the patient’s cooperation and discipline regarding the postoperative physiotherapy.