Acculturative Stress and Self-rated Health among Hispanic Emerging Adults: Examining the Moderating Effects of the Social Environment and Social Support.

Little is known about the impact of sociocultural stressors such as acculturative stress on self-rated health among Hispanics. We aimed to examine (a) associations between acculturative stress and self-rated health, and (b) the moderating effects of the community of settlement (i.e., Maricopa County, AZ and Miami-Dade County, FL) and social support on the association between acculturative stress and self-rated health. A hierarchical multiple regression model and moderation analyses were conducted using a cross-sectional sample of 200 Hispanic emerging adults from Arizona and Florida. Findings indicate that higher levels of pressure to acculturate are associated with lower levels of self-rated health. Community of settlement functioned as a moderator whereby pressure to acculturate was only associated with lower levels of self-rated health in Maricopa County. Lastly, a three-way interaction indicated that emotional social support mitigated the association between pressure to acculturate and self-rated health in Maricopa County. This study highlights the importance of accounting for community of settlement when examining associations between acculturative stress and health-related outcomes. A finding that may have implications for interventions is that social support may help to counteract the effects of acculturative stress.

Objective Measurement of Physical Activity Attributed to a Park-Based Afterschool Program.

BACKGROUND: Only 24% of US youth meet physical activity recommendations set by the Centers for Disease Control and Prevention. Research demonstrates that community-based programs provide underresourced minority youth with opportunities for routine physical activity, although limited work draws from accelerometry data. This study objectively assessed youth physical activity attributable to participation (vs nonparticipation) days in a park-based afterschool program in Miami-Dade County, Miami, FL. METHODS: Participants' (n = 66; 60% male; 57% white Hispanic, 25% non-Hispanic black, 14% Black Hispanic, mean age = 10.2 y) physical activity was assessed April to May 2019 over 10 days across 7 park sites using Fitbit (Charge 2) devices. Separate repeated-measures multilevel models were developed to assess the relationship between program daily attendance and total (1) moderate to vigorous physical activity minutes and (2) step counts per day. RESULTS: Models adjusted for individual-level age, sex, race/ethnicity, poverty, and clustering by park showed significantly higher moderate to vigorous physical activity minutes (ß = 25.33 more minutes per day; 95% confidence interval, 7.0 to 43.7, P < .01) and step counts (ß = 4067.8 more steps per day; 95% confidence interval, 3171.8 to 4963.8, P < .001) on days when youth did versus did not attend the program. CONCLUSIONS: Study findings suggest that park-based programs may support underserved youth in achieving daily physical activity recommendations.

Two-Year Changes in Neighborhood Juvenile Arrests After Implementation of a Park-Based Afterschool Mental Health Promotion Program in Miami-Dade County, Florida, 2015-2017.

Objectives. To examine the association of Fit2Lead, an afterschool park-based youth mental health promotion program, and neighborhood juvenile arrests (2015-2017) in Miami-Dade County, Florida. Methods. We tracked juvenile (ages 12-17 years) arrest rates over 2 years of program implementation across zip codes matched by (1) park and (2) baseline sociodemographics and youth arrests. Fit2Lead mental and physical health, meditation, resilience, and life skills activities were offered in 12 high-need areas for youths (n = 501) aged 12 to 17 years. We tested the association of Fit2Lead implementation (binary variable) and change in juvenile arrest rates by zip code, adjusting for area-level gender, age, race/ethnicity, single-parent households, and poverty. Results. Fit2Lead was offered in areas composed of 48% male youths, 60% Hispanics, 29% non-Hispanic Blacks, 33% single-parent households, and 33% of residents living in poverty. After covariate adjustment, zip codes with Fit2Lead implementation showed a significant mean reduction (P < .001) in youth arrests per 10 000 youths aged 12 to 17 years per year compared with zip codes without program implementation (b = -6.9; 95% confidence interval = -9.21, -4.65). Conclusions. Park-based programs may have the potential to promote mental health and resilience, and also to prevent violence among at-risk youths.

Longitudinal Impact of a Park-Based Afterschool Healthy Weight Program on Modifiable Cardiovascular Disease Risk Factors in Youth.

Community-based programs hold significant potential to prevent cardiovascular disease (CVD) risk in youth. We describe here the longitudinal change in several modifiable CVD risk factors after participation in up to 3 years of Fit2Play™, a park-based afterschool program. Children ages 6-15 years old (N = 2261, mean age 9.0 years, 50% Hispanic, 47% non-Hispanic black, 54% male) who participated in Fit2Play™ for either 1-3 school years between 2010 and 2016 had height, weight, 4-site skinfold thicknesses, systolic and diastolic blood pressure, the progressive aerobic cardiovascular endurance run test, and health/wellness knowledge and behavior scores collected at the beginning and end of the school year(s). Effects of length of Fit2Play™ participation on CVD outcomes were assessed via 2-level repeated measures analysis adjusted for child sociodemographics, park, area poverty, and year. Adjusted models showed overweight/obese children who participated in up to 3 years of Fit2Play™ had a mean reduction of 8 mm in skinfold thicknesses; almost 0.5 SD's in BMI z-score; 5 DBP %ile points; 17% reduction in probability of developing hypertension; and a mean increase of 6.4 PACER laps and 17% increase in health/wellness assessment compared to baseline. A dose-response trend was found for years of Fit2Play™ participation and improved CVD risk profile in participating youth. In conclusion, park-based afterschool programs that promote preventive CVD risk strategies can be an equitable, low-cost, high value tool for addressing our national epidemics of obesity, heart disease and diabetes and a rapidly changing healthcare system in need of evidence-based prevention programs.

Aetiology of non-diagnostic renal fine-needle aspiration cytologies in a contemporary series.

OBJECTIVES: To determine the aetiology of non-diagnostic renal fine-needle aspiration cytologies (FNACs) in a contemporary series. PATIENTS AND METHODS: We retrospectively reviewed our institutional database of renal FNACs performed between 1995 and 2005. There were 118 patients with renal lesions that underwent FNAC. Indications for FNAC were indeterminate complex renal cysts, significant medical comorbidities, previous history of malignancy, multiple bilateral renal lesions, and suspected metastatic disease. A cytotechnologist was present during the FNA procedure to perform Diff-Quik staining and ensure an adequate sample of cells were obtained. Except for seven (six open, one ultrasound-guided), all of the FNACs were performed with CT guidance. RESULTS: The median (range) number of passes for each FNAC session was 2.7 (1-6). Of the 16 FNACs performed for indeterminate complex renal cysts, nine (56%) were adequate with the cytodiagnosis of benign cysts. Of the seven inadequate specimens, three had benign cysts and another three were non-diagnostic due to acellularity. Therefore, the technical failure rate was 19% (3/16) for indeterminate complex renal cysts. The last patient had a cytodiagnosis of benign cyst and the final histological diagnosis of renal cell carcinoma (RCC; papilllary, grade III). Therefore, this represents a sampling error (false negative rate) of 0.8% (1/118). For the 102 solid renal masses, 22 (22%) had inadequate specimen by Diff-Quik staining. The technical failure rate (inability to obtain sufficient epithelial cells) was 16% (16). In 18 patients, immunocytochemistry (ICC) was used to differentiate primary renal parenchymal tumours from others such as transitional cell carcinoma (TCC), lymphoproliferative, colon, and lung. There were two FNACs with misdiagnosis (2%), where ICC was not used. In both, the cytodiagnosis was TCC and the final histological diagnosis was RCC in one and atypical urothelium in another. CONCLUSIONS: Non-diagnostic renal FNACs can be attributed to misdiagnosis (2%), sampling error (0.8%) and technical failure (16%).

Number of needle passes does not correlate with the diagnostic yield of renal fine needle aspiration cytology.

BACKGROUND AND PURPOSE: Renal Fine Needle Aspiration Cytology (FNAC) has gained popularity due to increasing options in management of renal lesions such as energy ablation and active surveillance. The diagnostic yield of renal FNAC varies between 40-90%. We hypothesized that adequate and diagnostic FNA samples would be associated with higher number of needle passes and higher number of slides examined. PATIENTS AND METHODS: The pathology database at our institution was retrospectively searched for renal FNACs performed between 1995 and 2005. Patient gender, side, indication, cytological diagnosis, final histological diagnosis when available, number of needle passes performed, number of slides examined, and adequacy of the FNAC sample as determined by Diff Quik staining by the cytotechnologist (CS) were recorded. Chi square test was performed for statistical analysis. RESULTS: Out of 377 renal biopsies performed, 259 were core biopsies for medical renal disease, and 118 were FNACs for renal lesions, including 16 for indeterminate complex renal cysts and 102 for solid renal masses. Indeterminate renal cysts were excluded from the study. Out of 102 FNACs for solid renal masses, 22 were inadequate with 13 (59%) being non-diagnostic; and 80 FNACs were adequate with 3 (4%) being non-diagnostic. The number of needle passes was not significantly different between non-diagnostic and diagnostic samples (2.5 vs 3.2); and between inadequate and adequate samples (3.4 vs 3.0). Similarly, the number of slides examined was not significantly different between non-diagnostic and diagnostic samples (9.5 vs 10.9); and between inadequate and adequate samples (11.3 vs 10.6). Diff Quik adequate samples had significantly higher diagnostic yields when compared to Diff Quik inadequate samples (965 vs 41%; p<0.01). CONCLUSIONS: The number of needle passes and microscopic slides examined did not correlate with sample adequacy or diagnostic yield of renal FNAC. Sample adequacy as determined by Diff Quik staining correlated with diagnostic FNAC. Despite the retrospective nature of this study, a cytotechnologist should be present during the FNA procedure to ensure adequate samples have been obtained to increase the diagnostic yield of renal FNAC.

Device failures associated with patient injuries during robot-assisted laparoscopic surgeries: a comprehensive review of FDA MAUDE database.

INTRODUCTION: Robot-assisted laparoscopic surgery has increased in the areas of cardiac and urologic surgery. We sought to determine the number of reported device malfunctions leading to patient injuries. METHODS: We performed a review of the MAUDE database of the FDA. Adverse events (AE) were defined as potential and actual product use errors and product quality problems. All incidents involving the ZEUS and da Vinci surgical robots were analyzed. RESULTS: The MAUDE database was last accessed on August 27, 2007. A total of 189 AEs were reported from 2000 to August 27, 2007. Assuming that 50,000 robotic-assisted laparoscopic cases have been performed, this represents 0.38% overall estimated failure rate. Twenty-one malfunctions were reported for the ZEUS robotic system between 2001 and 2003, while 168 malfunctions were reported for the da Vinci robotic system between 2000 and 2007. The rate of open conversions due to device malfunction decreased from 94% in 2003 to 16% in 2007. Of the 189 reported device malfunctions, only 9 (4.8%) were associated with patient injury. CONCLUSIONS: The increasing use of robotic-assisted surgery has led to an increase in the number of reported device malfunctions, albeit at a very small estimated rate of 0.38%. With experience, the rate of open conversions due to device malfunction decreased. Only a small percentage of these adverse occurrences were associated with patient injury.