Brief peer coaching complements daily digital messages for chronic disease prevention among young adult Latinas.

Young Latinas face multiple health challenges that place them at high risk for chronic diseases. Digital health promotion interventions can offer education and support to activate self-care and preventive behaviors. This pilot study evaluated a brief, theory-informed, culturally tailored intervention, Examen Tu Salud, that provided daily text and multimedia messages and weekly peer coaching via videoconference to improve health behaviors among young adult Latina women. Thirty-four participants who self-identified as Latina, female, and 18-29 years old were recruited from an urban college in Northern California to participate in a brief pilot test of the new intervention. Paired sample T-tests assessed health behavior and health activation changes from baseline to 1 month follow-up. Program participation and satisfaction were analyzed to assess feasibility of the intervention. Among 31 participants (91% completion), there were medium to large improvements in health outcomes. Confidence in preventing and managing one's health (t[30] = 5.18, p < .001, d = 0.93), days of moderate-intensity physical activity (t[30] = 3.50, p < .001, d = 0.63), and fruit (t[30] = 3.32, p = .001, d = 0.60) and vegetable (t[30] = 2.04, p = .025, d = 0.37) consumption in a typical day increased. Intervention satisfaction and engagement with health coaches was high. We found that a brief digital coaching intervention designed for young adult Latinas has the potential to improve health activation and behaviors. More attention is needed to prevent chronic conditions among a growing number of Latinos in the USA.

Using technology for health interventions is a promising approach for reaching Latinas, who face unique challenges to preventing obesity, diabetes, and other chronic diseases. While Latinos often use their mobile phones for health education, there is a need for preventive interventions which are designed to consider Latinos' cultural values and needs. We designed culturally relevant text and multimedia messages and peer coaching sessions specifically for young Latinas, then evaluated changes in their health behaviors. After 4 weeks, participants showed positive changes in their eating and exercise habits, as well as a positive attitude toward making changes in their health behaviors. Examen Tu Salud and its approach offer a framework for other communities in need of accessible and culturally adapted health interventions.

Expanding opportunities for chronic disease prevention for Hispanics: the Better Together REACH program in Pennsylvania.

Background: Hispanics in Lebanon and Reading, Pennsylvania, experience high levels of socioeconomic and health disparities in risk factors for chronic disease. In 2018, our community-academic coalition "Better Together" received a Racial and Ethnic Approaches to Community Health (REACH) award to improve healthy lifestyles. This report describes our work-in-progress and lessons learned to date from our REACH-supported initiatives in Lebanon and Reading. Methods: For the past 4 years, our coalition has leveraged strong community collaborations to implement and evaluate culturally-tailored practice- and evidence-based activities aimed at increasing physical activity, healthy nutrition, and community-clinical linkages. This community case report summarizes the context where our overall program was implemented, including the priority population, target geographical area, socioeconomic and health disparities data, community-academic coalition, conceptual model, and details the progress of the Better Together initiative in the two communities impacted. Results: To improve physical activity, we are: (1) creating new and enhancing existing trails connecting everyday destinations through city redesigning and master planning, (2) promoting outdoor physical activity, (3) increasing awareness of community resources for chronic disease prevention, and (4) supporting access to bikes for youth and families. To improve nutrition, we are: (1) expanding access to locally-grown fresh fruit and vegetables in community and clinical settings, through the Farmers Market Nutrition Program to beneficiaries of the Women, Infants, and Children (WIC) program and the Veggie Rx to patients who are at risk for or have diabetes, and (2) providing bilingual breastfeeding education. To enhance community-clinical linkages, we are training bilingual community health workers to connect at-risk individuals with diabetes prevention programs. Conclusions: Intervening in areas facing high chronic disease health disparities leads us to develop a community-collaborative blueprint that can be replicated across Hispanic communities in Pennsylvania and the United States.

Understanding the implementation of health checks in the prevention and early detection of chronic diseases among Aboriginal and Torres Strait Islander people in Australia: a realist review protocol.

INTRODUCTION: Chronic disease remains the leading cause of morbidity and mortality among Aboriginal and Torres Strait Islander peoples in Australia. Regular structured, comprehensive health assessments are available to Aboriginal and Torres Strait Islander people as annual health checks funded through the Medicare Benefits Schedule. This realist review aims to identify context-specific enablers and tensions and contribute to developing an evidence framework to guide the implementation of health checks in the prevention and early detection of chronic diseases for Aboriginal and Torres Strait Islander people. METHODS AND ANALYSIS: The review will involve the following steps: (1) Aboriginal and Torres Strait Islander engagement and research governance; (2) defining the scope of the review; (3) search strategy; (4) screening, study selection and appraisal; (5) data extraction and organisation of evidence; (6) data synthesis and drawing conclusions. This realist review will follow the Realist and MEta-narrative Evidence Syntheses: Evolving Standards guidance and will be reported as set up by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols statement. The realist programme theory will be developed through a literature review using multiple database searches from 1 November 1999 to 31 June 2022, limited to the English language, and stakeholder consultation, which will be refined throughout the review process. The study findings will be reported by applying the context-mechanism-outcome configuration to gain a deeper understanding of context and underlying mechanisms that influence the implementation of health checks in the prevention and early detection of chronic diseases among Aboriginal and Torres Strait Islander people in Australia. ETHICS AND DISSEMINATION: Ethical approval is not required as this review will be using secondary data. Findings will be published in a peer-reviewed journal and presented at scientific conferences. SYSTEMATIC REVIEW REGISTRATION: The review protocol has been registered on the international prospective register of systematic reviews: CRD42022326697.

Programa de salud cardiovascular: atenciones en Santiago de Chile en contexto de pandemia / Cardiovascular health program: service in Santiago de Chile during the pandemic

Introducción: Las enfermedades cardiovasculares son una de las principales causas de morbilidad y mortalidad en las Américas y en Chile. La pandemia por COVID-19 ha impactado la oferta de servicios de salud en la atención primaria, afectando el cuidado de las comunidades con alta prevalencia de enfermedades crónicas. En Chile, el Programa de Salud Cardiovascular brinda atención multiprofesional a personas con estas enfermedades en la atención primaria. Objetivo: Describir la variación de las prestaciones de servicios del Programa de Salud Cardiovascular en las comunas de la provincia de Santiago de Chile, durante el periodo 2014-2020 y su relación con la pobreza multidimensional en el periodo de pandemia. Método: Estudio descriptivo y ecológico. Se analizó la variación porcentual de las atenciones de enfermería, medicina y nutrición para cada comuna de la provincia de Santiago durante 2014-2020, utilizando registros del Ministerio de Salud de Chile. Se indagó en la variación 2019-2020 como descripción de la provisión de servicios del Programa de Salud Cardiovascular durante el primer año de pandemia y se analizó su asociación con la pobreza multidimensional. Resultados: La pandemia por COVID-19 impactó fuertemente en las atenciones del Programa de Salud Cardiovascular en la provincia de Santiago. Los controles disminuyeron en promedio un 60.43 %. Los controles de nutrición fueron los más afectados y los menos afectados los controles por medicina. Este impacto no se asoció con el nivel de pobreza multidimensional de cada comuna. Conclusiones: La magnitud en la disminución de atenciones revela la importancia de realizar vigilancia a la oferta de atenciones y ofrece una oportunidad para adelantarse a las consecuencias que esto implica.

Introduction: Cardiovascular diseases are the main cause of morbidity and mortality in the Americas and in Chile. The COVID-19 pandemic has impacted the supply of health services in primary care, affecting the attention of communities with a high prevalence of chronic diseases. In Chile, the Cardiovascular Health Program provides multi-professional primary care to people with these diseases. Aim: To describe the variation in the care assistance of the Cardiovascular Health Program to the communities of the province of Santiago de Chile, along the period of 2014 to 2020 and its relation to the multidimensional poverty during the pandemic. Method: This is a descriptive and ecological study. The percentage of variation in nursing, medicine, and nutrition care was analyzed for each community, using the records of the Ministry of Health of Chile. The variation from 2019 to 2020 was investigated as a description of the assistance of the Cardiovascular Health Program provided during the first year of the pandemic and its association with multidimensional poverty. Results: The COVID-19 pandemic strongly impacted the quality of assistance of the Cardiovascular Health Program control services in the province of Santiago. The controls decreased by an average of 60.43 %. The nutrition services were the most affected and the least affected were the physician services. This impact was not associated with the multidimensional poverty level in each community. Conclusions: It is important to monitor the impact of the pandemic on the assistance of the most prevailing chronic diseases in the population and to anticipate the consequences that this implies.

Introdução: As doenças cardiovasculares são uma das principais causas de morbidade e mortalidade nas Américas e no Chile. A pandemia da COVID-19 impactou a oferta dos serviços de saúde na atenção primária, afetando o atendimento de comunidades com alta prevalência de doenças crónicas. No Chile, o Programa de Saúde Cardiovascular oferece atendimento multiprofissional às pessoas com essas doenças na atenção primária. Objetivo: Descrever a variação na prestação de serviços do Programa de Saúde Cardiovascular nos municípios da província de Santiago do Chile, durante o período 2014-2020 e sua relação com a pobreza multidimensional no período pandêmico. Método: Estudo descritivo e ecológico. A variação percentual das atenções de enfermagem, medicina e nutrição para cada comuna da província de Santiago durante 2014-2020, usando os registos do Ministério da Saúde do Chile. A variação 2019-2020 foi investigada como descrição da prestação de serviços do Programa de Saúde Cardiovascular durante o primeiro ano da pandemia e analisou-se a sua associação com a pobreza multidimensional. Resultados: A pandemia da COVID-19 teve forte impacto no atendimento do Programa de Saúde Cardiovascular na província de Santiago. Os controles diminuíram em média 60,43%. Os controles por nutricionista foram os mais afetados e os menos foram os controles pelo médico. Este impacto não foi associado ao nível de pobreza multidimensional de cada comunidade. Conclusões: A magnitude da diminuição do atendimento revela a importância do monitoramento da oferta de atenção e oferece uma oportunidade de antecipar as consequências que isso implica.

Assessing the current and desired levels of training and applied experiences in chronic disease prevention of students during medical school.

INTRODUCTION: Chronic diseases account for approximately 70% of deaths in the U.S. annually. Though physicians are uniquely positioned to provide behavior change counseling for chronic disease prevention, they often lack the necessary training and self-efficacy. This study examined medical student interest in receiving chronic disease prevention training as a formal part of their education as part of an effort to enhance their ability to provide guidance to patients in the future. METHODS: A 23-question, online survey was sent to all undergraduate medical students enrolled in a large medical education program. The survey assessed medical student interest in receiving training related to chronic disease prevention. Survey topics included student awareness of primary prevention programs, perceived importance of receiving training and applied experience in chronic disease prevention, and preferences for how and when to receive this training. RESULTS: Of 793 eligible medical students, 432 completed the survey (54.5%). Overall, 92.4% of students reported receiving formal training in physical activity, public health, nutrition, obesity, smoking cessation, and chronic diseases was of "very high" or "high" importance. Despite this level of importance, students most frequently reported receiving no or 1-5 h of formal training in a number of topics, including physical activity (35.4% and 47.0%, respectively) and nutrition (16.9% and 56.3%, respectively). The level of importance given to public health training was significantly greater across degree type (p = 0.0001) and future specialty (p = 0.03) for MD/MPH students and those interested in primary care, respectively. CONCLUSIONS: While medical students perceive chronic disease prevention as an important topic, most reported receiving little to no formal training. To address the growing prevalence of chronic disease across our society, programs schools should place greater emphasis on integrating training in physical activity, nutrition, and obesity-related content into the medical education curriculum.

Revisiting the role of hyperbaric oxygen therapy in knee injuries: Potential benefits and mechanisms.

Knee injury negatively impacts routine activities and quality of life of millions of people every year. Disruption of tendons, ligaments, and articular cartilage are major causes of knee lesions, leading to social and economic losses. Besides the attempts for an optimal recovery of knee function after surgery, the joint healing process is not always adequate given the nature of intra-articular environment. Based on that, different therapeutic methods attempt to improve healing capacity. Hyperbaric oxygen therapy (HBOT) is an innovative biophysical approach that can be used as an adjuvant treatment post-knee surgery, to potentially prevent chronic disorders that commonly follows knee injuries. Given the well-recognized role of HBOT in improving wound healing, further research is necessary to clarify the benefits of HBOT in damaged musculoskeletal tissues, especially knee disorders. Here, we review important mechanisms of action for HBOT-induced healing including the induction of angiogenesis, modulation of inflammation and extracellular matrix components, and activation of parenchyma cells-key events to restore knee function after injury. This review discusses the basic science of the healing process in knee injuries, the role of oxygen during cicatrization, and shed light on the promising actions of HBOT in treating knee disorders, such as tendon, ligament, and cartilage injuries.

A resiliência psicológica e as práticas de autocuidado relacionadas à promoção da saúde e prevenção de doenças crônicas não transmissíveis em mulheres em atendimento ambulatorial / Psychological resilience and self-care practices related to health promotion and prevention of chronic non-communicable diseases in women in outpatient care

As doenças crônicas não transmissíveis mais prevalentes no mundo são as doenças cardiovasculares, diabetes mellitus, alguns tipos de câncer e doenças respiratórias crônicas. Juntas essas condições foram responsáveis por mais da metade das mortes ocorridas no mundo e no Brasil e constituem o principal problema de saúde. As práticas de autocuidado com a saúde têm sido apontadas como a parte que cabe ao paciente nas estratégias de promoção da saúde. Alguns estudos vêm abordando a resiliência como um importante indicador para a realização de práticas saudáveis de autocuidado, estando associada à autonomia e às habilidades para a autogestão da saúde. O objetivo deste estudo é analisar a associação entre a resiliência psicológica e o autocuidado com a saúde em mulheres adultas. O estudo foi realizado com 159 pacientes dos ambulatórios de ginecologia do Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira, da Fundação Oswaldo Cruz. Foi utilizada a versão brasileira da Escala de Resiliência de Wagnild & Young e um questionário adaptado do Inquérito Vigilância de Fatores de Risco e Proteção para Doenças Crônicas por Inquérito Telefônico. O principal resultado foi importância do contexto familiar para os níveis de resiliência, principalmente para mulheres que têm filhos. Não foram encontradas associações significativas entre resiliência e as variáveis de autocuidado. Novas pesquisas deverão ser desenvolvidas para esclarecer as possíveis relação entre resiliência e autocuidado e a importância da informação em saúde para promover mudanças de estilo de vida.

The most prevalent chronic non-communicable diseases in the world are cardiovascular diseases, diabetes mellitus, some types of cancer and chronic respiratory diseases. Together, these conditions were responsible for more than half of the deaths in the world and in Brazil, they constitute the main health problem. Health self-care practices have been identified as the patient's part in health promotion strategies. Some studies have approached resilience as an important indicator for healthy self-care practices, being associated with autonomy and skills for self-management of health. The aim of this study is to analyze the association between psychological resilience and self-care with health in adult women. The study was carried out with 159 patients from the gynecology outpatient clinics of the Fernandes Figueira National Institute of Women's, Children and Adolescents' Health of the Oswaldo Cruz Foundation. The Brazilian version of the Wagnild & Young Resilience Scale and a questionnaire adapted from the Surveillance of Risk and Protection Factors for Chronic Diseases by Telephone Survey were used. The main result was the importance of the family context for resilience levels, especially for women who have children. No significant associations were found between resilience and self-care variables. New research should be developed to clarify the possible relationship between resilience and self-care and the importance of health information to promote lifestyle changes.

La telemedicina como herramienta en tiempos de COVID-19 enPerú / The telemedicine as tool in times of COVID-19 inPerú

La pandemia de la COVID-19, enfermedad producida por el nuevo coronavirus, SARS- CoV-2, que apareció en la República Popular de China a finales del año 2019, ha causado un gran impacto negativo en la salud pública a nivel mundial.1 Además de provocar una alta tasa de contagios y muertes, ha transformado la vida de la humanidad. En el sector de la salud, su infraestructura, el personal y los protocolos de seguridad tuvieron que ser replanteados para enfrentarla, incluso a expensas de marginar del centro de atención a los pacientes de otras enfermedades.2 Con la llegada de la pandemia al Perú, el 30 de marzo de 2020, se implementaron de inmediato, bajo los criterios adecuados, los servicios de teleconsulta y telemonitoreo. El 10 de mayo del mismo año, la revisión del marco de la telemedicina marcó un hito importante para el sistema de salud integrado, pues permitió la prescripción digital de medicamentos, así como la transferencia en línea de datos personales y la historia clínica entre las instituciones y compañías de salud.3 Sin embargo, fundar el sistema nacional de telemedicina sobre la base de una infraestructura de internet insuficiente, inadecuado y caro, aún constituye un hecho eventual y limitado. Sobre todo, por la influencia determinante de las barreras de acceso que presenta la geografía accidentada y variada de Perú en las condiciones de la educación y la salud, con una relación inversamente proporcional al grado de dificultad para llegar al sitio. Según la región de que se trate, son también los comportamientos que se asocian con el tratamiento médico de urgencia y el uso indiscriminado de la automedicación (en el caso del tratamiento farmacológico), entre otros problemas de salud. Por ejemplo, en la costa, la sierra y la selva se reportan tasas de mortalidad en menores de cinco años del 26, 39 y 42 por ciento, respectivamente.4 Mientras, el reporte del 63,3 por ciento de la población de la costa, un 36 por ciento, de los Andes y un 33 por ciento, de la selva con acceso a internet, son muestras elocuentes de las marcadas diferencias existentes que también ha devenido en una especie de barrera tecnológica para los servicios de telemedicina a nivel nacional.3 Otro impedimento reportado es que casi el 70 por ciento de la población peruana no puede tener una computadora en casa o un teléfono inteligente con conexión a internet adecuado, por pertenecer a estratos socioeconómicos bajos y carecer de las imprescindibles habilidades tecnológicas para una teleconsulta. Sin embargo, se ha planteado una normativa relacionada con la telemedicina para avanzar y acercar la tecnología a los sectores más desposeídos.4 El 20 de abril de 2020, según el Ministerio de Salud del Perú (MINSA), luego de lanzar el sitio web de telemedicina Teleatiendo para solicitar consultas en línea, recibieron más de 4300 solicitudes en las primeras dos semanas del lanzamiento de dicho programa. Además, el gobierno creo la app Perú en tus manos, que permitió al personal médico conocer por medio del servicio de localización las zonas dónde había mayor probabilidad de contagios por la COVID-19.5 Durante los primeros meses de la pandemia en Perú, hubo un significativo retraso en el diagnóstico y tratamiento de miles de pacientes con enfermedades crónicas como el cáncer. Por ello, las áreas oncológicas de las clínicas privadas paulatina y parcialmente se abrieron y se elaboró una guía con los protocolos de bioseguridad, consultas en línea y telefónicas y, sobre el tratamiento general, quimioterapéutico y quirúrgico para tratarlos y evitarles una posible infección por COVID-19.2 Esta pandemia creó una oportunidad para ampliar los servicios de telemedicina y telemonitoreo a los pacientes, sin embargo, es necesario evaluar el tipo de servicio de salud que se implementa y las condiciones mínimas requeridas para su acceso. Además, se pronostica que la telemedicina en el Perú podría fortalecer los programas de prevención de las enfermedades crónicas en su población(AU)

Hormone Therapy for the Primary Prevention of Chronic Conditions in Postmenopausal Persons: US Preventive Services Task Force Recommendation Statement.

Importance: Menopause is defined as the cessation of a person's menstrual cycle. It is defined retrospectively, 12 months after the final menstrual period. Perimenopause, or the menopausal transition, is the few-year time period preceding a person's final menstrual period and is characterized by increasing menstrual cycle length variability and periods of amenorrhea, and often symptoms such as vasomotor dysfunction. The prevalence and incidence of most chronic diseases (eg, cardiovascular disease, cancer, osteoporosis, and fracture) increase with age, and US persons who reach menopause are expected on average to live more than another 30 years. Objective: To update its 2017 recommendation, the US Preventive Services Task Force (USPSTF) commissioned a systematic review to evaluate the benefits and harms of systemic (ie, oral or transdermal) hormone therapy for the prevention of chronic conditions in postmenopausal persons and whether outcomes vary by age or by timing of intervention after menopause. Population: Asymptomatic postmenopausal persons who are considering hormone therapy for the primary prevention of chronic medical conditions. Evidence Assessment: The USPSTF concludes with moderate certainty that the use of combined estrogen and progestin for the primary prevention of chronic conditions in postmenopausal persons with an intact uterus has no net benefit. The USPSTF concludes with moderate certainty that the use of estrogen alone for the primary prevention of chronic conditions in postmenopausal persons who have had a hysterectomy has no net benefit. Recommendation: The USPSTF recommends against the use of combined estrogen and progestin for the primary prevention of chronic conditions in postmenopausal persons. (D recommendation) The USPSTF recommends against the use of estrogen alone for the primary prevention of chronic conditions in postmenopausal persons who have had a hysterectomy. (D recommendation).

Hormone Therapy for the Primary Prevention of Chronic Conditions in Postmenopausal Persons: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force.

Importance: It is uncertain whether hormone therapy should be used for the primary prevention of chronic conditions such as heart disease, osteoporosis, or some types of cancers. Objective: To update evidence for the US Preventive Services Task Force on the benefits and harms of hormone therapy in reducing risks for chronic conditions. Data Sources: PubMed/MEDLINE, Cochrane Library, EMBASE, and trial registries from January 1, 2016, through October 12, 2021; surveillance through July 2022. Study Selection: English-language randomized clinical trials and prospective cohort studies of fair or good quality. Data Extraction and Synthesis: Dual review of abstracts, full-text articles, and study quality; meta-analyses when at least 3 similar studies were available. Main Outcomes and Measures: Morbidity and mortality related to chronic conditions; health-related quality of life. Results: Twenty trials (N = 39 145) and 3 cohort studies (N = 1 155 410) were included. Participants using estrogen only compared with placebo had significantly lower risks for diabetes over 7.1 years (1050 vs 903 cases; 134 fewer [95% CI, 18-237]) and fractures over 7.2 years (1024 vs 1413 cases; 388 fewer [95% CI, 277-489]) per 10 000 persons. Risks per 10 000 persons were statistically significantly increased for gallbladder disease over 7.1 years (1113 vs 737 cases; 377 more [95% CI, 234-540]), stroke over 7.2 years (318 vs 239 cases; 79 more [95% CI, 15-159]), venous thromboembolism over 7.2 years (258 vs 181 cases; 77 more [95% CI, 19-153]), and urinary incontinence over 1 year (2331 vs 1446 cases; 885 more [95% CI, 659-1135]). Participants using estrogen plus progestin compared with placebo experienced significantly lower risks, per 10 000 persons, for colorectal cancer over 5.6 years (59 vs 93 cases; 34 fewer [95% CI, 9-51]), diabetes over 5.6 years (403 vs 482 cases; 78 fewer [95% CI, 15-133]), and fractures over 5 years (864 vs 1094 cases; 230 fewer [95% CI, 66-372]). Risks, per 10 000 persons, were significantly increased for invasive breast cancer (242 vs 191 cases; 51 more [95% CI, 6-106]), gallbladder disease (723 vs 463 cases; 260 more [95% CI, 169-364]), stroke (187 vs 135 cases; 52 more [95% CI, 12-104]), and venous thromboembolism (246 vs 126 cases; 120 more [95% CI, 68-185]) over 5.6 years; probable dementia (179 vs 91 cases; 88 more [95% CI, 15-212]) over 4.0 years; and urinary incontinence (1707 vs 1145 cases; 562 more [95% CI, 412-726]) over 1 year. Conclusions and Relevance: Use of hormone therapy in postmenopausal persons for the primary prevention of chronic conditions was associated with some benefits but also with an increased risk of harms.

Menopausal Hormone Therapy for Prevention of Chronic Conditions.

This JAMA Patient Page summarizes the US Preventive Services Task Force's recommendations on use of hormone therapy for prevention of chronic conditions in postmenopausal individuals.