Efficacy of a lay community health worker (promotoras de salud) program to improve adherence to emollients in Spanish-speaking Latin American pediatric patients in the United States with atopic dermatitis: A randomized, controlled, evaluator-blinded study.

BACKGROUND: Latin American patients in the United States experience significant health disparities. Community health workers (promotoras de salud) reduce disparities by providing culturally appropriate education. While educational interventions have been studied in atopic dermatitis (AD), a chronic dermatologic condition affecting children, none have evaluated the use of promotoras in Spanish-speaking pediatric patients in the United States. OBJECTIVE: To create and evaluate a promotora-led education program for Spanish-speaking caregivers of Latin American, pediatric patients with AD through a randomized, controlled, evaluator-blinded study. METHODS: Children with moderate/severe AD (n = 48) were recruited from the pediatric dermatology clinic at Children's Health℠ in Dallas, TX and randomized to receive clinic education (n = 26) or clinic education plus promotora home visits (n = 22). The primary outcome was overall adherence to topical emollients over the 12-week study, quantified by MEMSCap™ devices; several secondary endpoints were evaluated. RESULTS: Intention-to-treat analysis revealed a trend toward increased overall adherence to emollients over the 12-week study period in promotora (median [interquartile range, IQR]: 43% [26%-61%]) versus non-promotora (median [IQR]: 20% [11%-49%]) (p = .09) groups. SCORAD, AD knowledge, and Spanish-language Parental Quality of Life Questionnaire for AD (Sp-PIQoL-AD) improved in both groups, although there was no statistically significant difference between groups. There was a trend toward increased AD knowledge at Week 4 (p = .06) in the promotora group. CONCLUSIONS: A promotora-led educational intervention is a promising approach in increasing caregiver medication adherence in pediatric, Latin American patients with AD in the United States. Further research using creative and culturally appropriate strategies to increase medication adherence is necessary to reduce health disparities in other racial and ethnic minority populations in the United States.

Hipoglicemia y factores asociados en recién nacidos: Un estudio observacional de centro único / Hypoglycemia and associated factors in neonates: A single-center observational study

Introducción: La hipoglicemia neonatal (HN) es una de las patologías metabólicas más frecuentes en el periodo neonatal, que aumentan la morbi-mortalidad en el recién nacido y que puede dejar secuelas de forma permanente; sin embargo, podría ser prevenida o diagnosticada y tratada tempranamente. El objetivo del presente estudio fue determinar los factores asociados a hipoglicemia neonatal, en recién nacidos del servicio de neonatología en un hospital público Vicente Corral Mosco-so en Cuenca-Ecuador. Métodos: El presente estudio de casos y controles, realizado de enero del 2018 a diciembre del 2019. Pareados por edad gestacional, sexo y residencia materna. Ingresaron al estudio pacientes con HN durante los primeros 7 días de vida. Los controles no presentaron HN. La muestra se tomó por conveniencia. Las variables fueron: Diabetes gestacional, Diabetes Mellitus tipo II no controlada, Pequeño para la edad gestacional, Macrosómico, Síndrome de dificultad respiratoria, Restricción del crecimiento intrauterino. La asociación se cuantificó mediante Odds Ratio con un Intervalo de Confianza del 95%. Resultados: Fueron 101 casos y 202 controles homogéneos en edad gestacional, sexo y, residencia materna (P>0.05). Los factores asociados a hipoglicemia neonatal estadísticamente significativos fueron: pequeños para la edad gestacional (OR 2.54; IC 1.54-4.20; P<0.001) y restricción del crecimiento intrauterino (OR 2,1; IC 1,29-3,54; P=0.003); mientras que diabetes gestacional (OR 1.2; IC 0.37-4.88; P=0.649), macrosomía (OR 1.2; IC 0.28-5.1; P=0.800) y, síndrome de dificultad respiratoria (OR 0.89; IC 0.54-1.47; P=0.672), no fueron estadísticamente significativos. Conclusión: La hipoglicemia neonatal está asociada a los factores como restricción del crecimiento intrauterino y pequeño para la edad gestacional.

Introduction: Neonatal hypoglycemia (NH) is one of the most frequent metabolic pathologies in the neonatal period. It increases morbidity and mortality in the newborn and can leave permanent sequelae; however, it can be prevented, diagnosed, and treated early. This study aimed to determine the factors associated with neonatal hypoglycemia in new-borns from the neonatology service at a Vicente Corral Moscoso public hospital in Cuenca-Ecuador. Methods: This case‒control study was conducted from January 2018 to December 2019. Matched by gestational age, sex, and maternal residence. Patients with NH entered the study during the first seven days of life, and the controls did not present NH. The sample was taken for convenience. The variables were gestational diabetes, uncontrolled type II diabetes mellitus, small for gestational age, macrosomal, respiratory distress syndrome, and intrauterine growth restriction. The association was quantified using the odds ratio with a confidence interval of 95%. Results: A total of 101 cases and 202 controls were homogeneous in gestational age, sex, and maternal residence (P>0.05). The factors associated with statistically significant neonatal hypoglycemia were small for gestational age (OR 2.54; CI 1.54-4.20; P<0.001) and intrauterine growth restriction (OR 2.1; CI 1.29-3.54; P= 0.003), while gestational diabetes (OR 1.2; IC 0.37-4.88; P=0.649), macrosomia (OR 1.2; IC 0.28-5.1; P=0.800) and respiratory distress syndrome (OR 0.89; IC 0.54-1.47; P=0.672) were not statistically significant. Conclusion: Neonatal hypoglycemia is associated with factors such as intrauterine growth restriction and small for gestational age.