Impact of Masking Academic Metrics on Enrolling a Broadly Diverse and Mission-Aligned Student Body.

PROBLEM: The June 2023 U.S. Supreme Court decision overturning affirmative action required medical schools to discontinue considering race/ethnicity in admissions decisions. Medical schools must now identify different strategies if they aim to recruit and admit applicants from groups underrepresented in medicine (URiM; race/ethnicity), as enrolling broadly diverse students remains critical for serving the U.S. population. APPROACH: Washington State University Elson S. Floyd College of Medicine (established in 2015) has an admissions process that assesses academic metrics using national threshold combinations of undergraduate grade point averages (UGPAs) and Medical College Admission Test (MCAT) scores (published on school's website), and legal residency in or ties to Washington state, as prescreening criteria for secondary applications. UGPAs and MCAT scores are then masked from further consideration, allowing for decisions to be made with a focus on mission-aligned criteria, such as certain personal attributes and lived experiences and coming from specific environments (i.e., educationally or socioeconomically disadvantaged backgrounds, rural communities, military service, or a member of a federally recognized Tribe). OUTCOMES: In the last 5 admissions cycles (enrollment years 2018-2022), cohort data demonstrates that as the admissions funnel narrows and each subsequent pool is smaller than the preceding one, the representation of mission-aligned applicants increases, despite the masking of academic metrics. The most recently enrolled class (enrollment year 2022) of 80 had 14 (17.5%) URiM students, closely mirroring the state's general population. The overall yield (acceptance:matriculation) has steadily improved with the last 2 cycles to 1.68:1 and 1.65:1, indicating slightly more than 1.5 times the number of offers needed to fill the class are being made. NEXT STEPS: Next steps include further refining the process by considering more granular data on applicants' childhood community characteristics and rural background and examining how admissions data may correlate with residency and practice location and communities served.

Adherence to a Traditional Mexican Diet Is Associated with Lower Hepatic Steatosis in US-Born Hispanics of Mexican Descent with Overweight or Obesity.

Hispanics of Mexican descent have disproportionate rates of non-alcoholic fatty liver disease (NAFLD). The purpose of this work is to investigate the association between the traditional Mexican diet score (tMexS) and hepatic steatosis and fibrosis, two NAFLD-related clinical endpoints, in Hispanic adults of Mexican descent. Data from 280 Hispanic adults of Mexican descent (n = 102 men, 178 women) with overweight or obesity enrolled in a cross-sectional observational study were analyzed. The tMexS was calculated from 24 h dietary recalls. Hepatic steatosis and fibrosis measurements were assessed using transient elastography (Fibroscan®). Linear regression models testing the association between tMexS and hepatic steatosis and fibrosis were run individually and through the stratification of significant modifiers. Mean tMexS were 5.9 ± 2.1, hepatic steatosis scores were 288.9 ± 48.9 dB/m, and fibrosis scores were 5.6 ± 2.2 kPa. Among the US-born group, with every point increase in the tMexS, there was a statistically significant 5.7 lower hepatic steatosis point (95% CI: -10.9, -0.6, p-value = 0.07). Higher adherence to a traditional Mexican diet was associated with lower hepatic steatosis in US-born Hispanics of Mexican descent. Findings from the current work may serve to inform future culturally relevant interventions for NAFLD prevention and management in individuals of Mexican descent.

Correlation between Health and eHealth Literacy and a Healthy Lifestyle: A Cross-Sectional Study of Spanish Primary Healthcare Patients.

BACKGROUND: Health literacy and eHealth literacy play a crucial role in improving a community's ability to take care of themselves, ultimately leading to a reduction in disparities in health. Embracing a healthy way of living is vital in lessening the impact of illnesses and extending one's lifespan. This research delves into the link between the health and eHealth literacy levels of individuals accessing primary healthcare services and investigates how this relates to adopting a health-conscious lifestyle. METHODS: The approach involves a cross-sectional examination carried out at a healthcare facility in the Madrid region of Spain, focusing on adult patients who are in need of primary care nursing services. Health and eHealth literacy and a healthy lifestyle were measured using the Health Literacy Questionnaire (HLQ), the eHealth Literacy Questionnaire (eHLQ), and the "PA100" questionnaire, respectively. RESULTS: Only some of the dimensions of the HLQ and eHLQ were significantly related to a healthy lifestyle, predominantly with a very low or low relationship. Dimension three of the HLQ and dimension five of the eHLQ acquired more importance and were positioned as positive predictors of a healthy lifestyle. CONCLUSIONS: This study helps comprehend the relationship between health and eHealth literacy and a healthy lifestyle, which provides information that contributes to understanding the factors that might have a higher impact on lifestyles.

Cultural Influences Catalyzing Resident Scholarly Productivity.

BACKGROUND AND OBJECTIVES: Scholarly activity is a core requirement set by the Accreditation Council for Graduate Medical Education (ACGME). A previous study documented a significant 302% increase in scholarly activity at Eglin Family Medicine Residency after implementation of a standard set of interventions from 2016 to 2019. Few researchers have explained why such interventions to increase scholarly activity are effective. Prior work has suggested that many different interventions are helpful, but why? Our qualitative study took a multilevel approach to explain accompanying cultural factors and to determine how specific interventions led to the observed increases in quality and quantity of resident scholarship. METHODS: Taking a grounded theory qualitative approach, we interviewed a cross-section of high- and low-producing residents (12) and faculty (5) using a semistructured interview guide. Data analysis occurred concurrently with interviews. The team iterated the interview guide three times until core code saturation was achieved. Then axial coding occurred, and our team developed a grounded theory of scholarship cultural change. RESULTS: During the transformation period of 2016 to 2019, participants identified mentorship availability, interest/opportunity alignment, research mechanics demystification, leadership support affecting productivity, and scholarship begets scholarship as key factors that promulgated the culture change leading to increased scholarship productivity. No single factor led to increased scholarship. Collectively, they mutually reinforced one another. CONCLUSIONS: This explanatory inquiry developed into a multilevel model which suggests that the synergy of promoting elements drives increased scholarly productivity. Other residencies should consider fostering these combined elements instead of emphasizing only isolated individual elements to increase resident scholarship productivity.

Determinants of Pneumonia mortality in Bogota, Colombia: A spatial econometrics approach.

Bogota, the capital and largest city of Colombia, constantly fights against easily transmitted and endemic-epidemic diseases that lead to enormous public health problems. Pneumonia is currently the leading cause of mortality attributable respiratory infections in the city. Its recurrence and impact have been partially explained by biological, medical, and behavioural factors. Against this background, this study investigates Pneumonia mortality rates in Bogota from 2004 and 2014. We identified a set of environmental, socioeconomic, behavioural, and medical care factors whose interaction in space could explain the occurrence and impact of the disease in the Iberoamerican city. We adopted a spatial autoregressive models framework to study the spatial dependence and heterogeneity of Pneumonia mortality rates associated with well-known risk factors. The results highlight the different types of spatial processes governing Pneumonia mortality. Furthermore, they demonstrate and quantify the driving factors that stimulate the spatial spread and clustering of mortality rates. Our study stresses the importance of spatial modelling of context-dependent diseases such as Pneumonia. Likewise, we emphasize the need to develop comprehensive public health policies that consider the space and contextual factors.

Demographic and Socioeconomic Factors in Prospective Retina-Focused Clinical Trial Screening and Enrollment.

Historically marginalized populations are disproportionately affected by many diseases that commonly affect the retina, yet they have been traditionally underrepresented in prospective clinical trials. This study explores whether this disparity affects the clinical trial enrollment process in the retina field and aims to inform future trial recruitment and enrollment. Age, gender, race, ethnicity, preferred language, insurance status, social security number (SSN) status, and median household income (estimated using street address and zip code) for patients referred to at least one prospective, retina-focused clinical trial at a large, urban, retina-based practice were retrospectively extracted using electronic medical records. Data were collected for the 12-month period from 1 January 2022, through 31 December 2022. Recruitment status was categorized as Enrolled, Declined, Communication (defined as patients who were not contacted, were contacted with no response, were waiting for a follow-up, or were scheduled for screening following a clinical trial referral.), and Did Not Qualify (DNQ). Univariable and multivariable analyses were used to determine significant relationships between the Enrolled and Declined groups. Among the 1477 patients, the mean age was 68.5 years old, 647 (43.9%) were male, 900 (61.7%) were White, 139 (9.5%) were Black, and 275 (18.7%) were Hispanic. The distribution of recruitment status was: 635 (43.0%) Enrolled, 232 (15.7%) Declined, 290 (19.6%) Communication, and 320 (21.7%) DNQ. In comparing socioeconomic factors between the Enrolled and Declined groups, significant odds ratios were observed for age (p < 0.02, odds ratio (OR) = 0.98, 95% confidence interval (CI) [0.97, 1.00]), and between patients who preferred English versus Spanish (p = 0.004, OR = 0.35, 95% CI [0.17, 0.72]. Significant differences between the Enrolled and Declined groups were also observed for age (p < 0.05), ethnicity (p = 0.01), preferred language (p < 0.05), insurance status (p = 0.001), and SSN status (p < 0.001). These factors may contribute to patient participation in retina-focused clinical trials. An awareness of these demographic and socioeconomic disparities may be valuable to consider when attempting to make clinical trial enrollment an equitable process for all patients, and strategies may be useful to help address these challenges.

Derivation and Validation of a Clinical Risk Assessment Model for Cancer-Associated Thrombosis in Two Unique US Health Care Systems.

PURPOSE: Venous thromboembolism (VTE), especially pulmonary embolism (PE) and lower extremity deep vein thrombosis (LE-DVT), is a serious and potentially preventable complication for patients with cancer undergoing systemic therapy. METHODS: Using retrospective data from patients diagnosed with incident cancer from 2011-2020, we derived a parsimonious risk assessment model (RAM) using least absolute shrinkage and selection operator regression from the Harris Health System (HHS, n = 9,769) and externally validated it using the Veterans Affairs (VA) health care system (n = 79,517). Bootstrapped c statistics and calibration curves were used to assess external model discrimination and fit. Dichotomized risk strata using integer scores were created and compared against the Khorana score (KS). RESULTS: Incident VTE and PE/LE-DVT at 6 months occurred in 590 (6.2%) and 437 (4.6%) patients in HHS and 4,027 (5.1%) and 3,331 (4.2%) patients in the VA health care system. Assessed at the time of systemic therapy initiation, the new RAM included components of the KS with the modified cancer subtype, cancer staging, systemic therapy class, history of VTE, history of paralysis/immobility, recent hospitalization, and Asian/Pacific Islander race. The c statistic was 0.71 in HHS and 0.68 in the VA health care system (compared with 0.65 and 0.60, respectively, for KS). Furthermore, the new RAM appropriately reclassified 28% of patients and increased the proportion of VTEs in the high-risk group from 37% to 68% in the validation data set. CONCLUSION: The novel RAM stratified patients with cancer into a high-risk group with 8%-10% cumulative incidence of VTE and 7% PE/LE-DVT at 6 months (v 3% and 2%, respectively, in the low-risk group). The model had improved performance over the original KS and doubled the number of VTE events in the high-risk stratum. We encourage additional external validation from prospective studies.[Media: see text].

The Economic Value of Coastal Amenities: Evidence from Beach Capitalization Effects in Peer-to-Peer Markets.

Coastal amenities are public goods that represent an important attraction for tourism activities. This paper studies the capitalization effects of beach characteristics using hedonic pricing methods. We examine the implicit economic value of several beach characteristics like sand type, width, longitude, accessibility, or frontage in the Airbnb rental market. Using data for 16,663 Airbnb listings located in 67 municipalities of the Balearic Islands (Spain) during the summer of 2016, together with detailed information about the attributes of 263 beaches, our modelling approach considers interaction terms between the beach amenities and distance to the closest beach. Controlling for a set of listings' structural characteristics, host attributes and municipality fixed effects, we find that Airbnb guests attach economic value to beach length, the presence of vegetation, the type of coastal frontage and beach accessibility and exclusivity. However, there is no evidence of capitalization effects associated with beach width or the type of sand. Supplementary Information: The online version contains supplementary material available at 10.1007/s10640-022-00735-5.

Adaptation of the SAGEFS scale on attitudes toward gender equality in football in the international school context.

The objective of the present study is to evaluate the psychometric properties of the Scale of Attitudes toward Gender Equality in Football in the Context of Schools (SAGEFS) in the international context. This sample was formed by N = 6,101 students. The study was conducted by applying the SAGEFS. The model of the three factors correlated in the complete sample and for each country was correlated using AFC. The structural model was appraised by employing eight indices: the relative Chi-squared index; the goodness of fit index and its adjusted formula; the normal fit index; the comparative fit index; the standardized Quadratic Mean; and the Quadratic Mean Error of Approximation. To conclude, the results evidence the presence of psychometric properties that are indispensable for the measurement of attitudes toward gender equality in the context of schools.

Health Literacy and Its Sociodemographic Predictors: A Cross-Sectional Study of a Population in Madrid (Spain).

BACKGROUND: Health literacy enhances a population's self-care capacity and helps to reduce health inequalities. This work examines the health literacy of a population attending primary care services and explores its relationship with sociodemographic factors. METHODS: This cross-sectional study, conducted at a healthcare center in the Madrid region (Spain), involved adult patients requiring primary care nursing services. One hundred and sixty-six participants were recruited via systematic random sampling. Health literacy was measured using the Health Literacy Questionnaire (HLQ). RESULTS: The studied population showed higher health literacy scores for literacy dimensions 1 (feeling understood and supported by healthcare providers) and 4 (social support for health); the lowest scores were recorded for dimensions 5 (appraisal of health information) and 8 (ability to find good health information). People with a better perceived health status showed a higher level of health literacy. People over 65 years of age, those with an incomplete secondary education, and those who were unemployed returned lower scores for several literacy dimensions. CONCLUSIONS: The results contribute to our understanding of the factors that influence health literacy. Identifying the areas in which patients show the poorest health literacy may help us comprehend their needs and better support them.

An economic evaluation of cabazitaxel versus a second androgen receptor-targeted agent (ARTA) for patients with metastatic castration-resistant prostate cancer previously treated with docetaxel and an ARTA: the United States payer perspective.

BACKGROUND: Cabazitaxel significantly improves clinical outcomes compared with a second androgen receptor-targeted agent (ARTA) in patients with metastatic castration-resistant prostate cancer (mCRPC) previously treated with docetaxel and an ARTA (abiraterone or enzalutamide), as demonstrated in the CARD trial (NCT02485691). We aimed to estimate healthcare costs avoided with the use of cabazitaxel as a third-line (3 L) treatment versus a second ARTA from a US payer perspective. METHODS: Model inputs were based on the CARD trial, published sources, and estimates of typical clinical care patterns by genitourinary oncologists (n = 3). Assessed time points were 6, 12, 18, and 24 months. Outcomes included progression-free survival (PFS), radiographic PFS (rPFS), and overall survival (OS); hospitalization and intensive care unit (ICU) days; and costs (reported in 2020 US dollar [USD] and converted into Euro) to manage symptomatic skeletal events (SSEs), adverse events (AEs), and end-of-life care. RESULTS: At 18 months, in a cohort of 100 patients, the use of cabazitaxel was estimated to result in 9 more patients achieving rPFS, 2 more patients achieving PFS, and 17 more survivors versus a second ARTA. The costs of SSEs, AEs, and end-of-life care were $498,909 (€424,073), $276,198 (€234,768), and $808,785 (€687,468), respectively, for cabazitaxel and $627,569 (€533,434), $251,124 (€213,455), and $1,028,294 (€874,050), respectively, for a second ARTA. Cabazitaxel was estimated to be associated with a 21% reduction in both SSE management and end-of-life care costs. Hospitalization cost was $1,442,870 (€1,226,440) for cabazitaxel and $1,728,394 (€1,469,135) for a second ARTA, representing an estimated 17% reduction in these costs. Cabazitaxel, as compared with a second ARTA, was associated with 58 fewer hospitalization days and 2 fewer ICU days and was estimated to avoid $323,095 (€274,630, 17%) in total costs, driven by SSEs management and end-of-life care. CONCLUSION: The use of cabazitaxel as a 3 L treatment after docetaxel and an ARTA in patients with mCRPC is estimated to result in clinical benefits (longer rPFS, PFS, and OS) and lower healthcare resource utilization (fewer hospitalization and ICU days), compared with a second ARTA.

Assessment of the Effectiveness of Omicron Transmission Mitigation Strategies for European Universities Using an Agent-Based Network Model.

BACKGROUND: Returning universities to full on-campus operations while the coronavirus disease 2019 pandemic is ongoing has been a controversial discussion in many countries. The risk of large outbreaks in dense course settings is contrasted by the benefits of in-person teaching. Transmission risk depends on a range of parameters, such as vaccination coverage and efficacy, number of contacts, and adoption of nonpharmaceutical intervention measures. Owing to the generalized academic freedom in Europe, many universities are asked to autonomously decide on and implement intervention measures and regulate on-campus operations. In the context of rapidly changing vaccination coverage and parameters of the virus, universities often lack sufficient scientific insight on which to base these decisions. METHODS: To address this problem, we analyzed a calibrated, data-driven agent-based simulation of transmission dynamics among 13 284 students and 1482 faculty members in a medium-sized European university. Wed use a colocation network reconstructed from student enrollment data and calibrate transmission risk based on outbreak size distributions in education institutions. We focused on actionable interventions that are part of the already existing decision process of universities to provide guidance for concrete policy decisions. RESULTS: Here we show that, with the Omicron variant of the severe acute respiratory syndrome coronavirus 2, even a reduction to 25% occupancy and universal mask mandates are not enough to prevent large outbreaks, given the vaccination coverage of about 85% reported for students in Austria. CONCLUSIONS: Our results show that controlling the spread of the virus with available vaccines in combination with nonpharmaceutical intervention measures is not feasible in the university setting if presence of students and faculty on campus is required.

Hair Stylists as Lay Health Workers: Perspectives of Black Women on Salon-Based Health Promotion.

Lay health workers (LHWs) have been effective in delivering health promotion to underserved, vulnerable populations. Hair stylists are well positioned to serve as LHWs in addressing health disparities among Black women in the U.S. The purpose of this qualitative study was to explore the extent to which hair stylists influence their Black female clients and clients' preferences for their stylist's role in salon-based health promotion programming. Eight virtual platform focus groups were conducted with Black women (n = 39) who receive hair care services from a licensed hair stylist across the U.S. Most participants had a college degree (89.8%), health insurance (92.3%), a primary care provider (89.7%), and the majority had at least one chronic disease (56.4%). Participants reported higher potential for influence related to level of trust in the stylists and for stylists they find relatable and credible. Trust, relatability, and credibility were further determined by racial and gender congruence. Client interviewees felt stylists should model healthy behaviors and reported they may not be receptive to stylist-delivered health promotion out of the context of a hair-health connection. In this sample of well-educated clients, there was an expressed preference for stylists to provide referral to healthcare professionals or solicit experts for health topics out of the scope of haircare rather than guide the health promotion efforts themselves. Findings from this study can inform future development of acceptable salon-based, stylist-led health promotion programs that partner stylists with health experts to deliver health promotion.

Assessment of motion and model bias on the detection of dopamine response to behavioral challenge.

Compartmental modeling analysis of 11C-raclopride (RAC) PET data can be used to measure the dopaminergic response to intra-scan behavioral tasks. Bias in estimates of binding potential (BPND) and its dynamic changes (ΔBPND) can arise both when head motion is present and when the compartmental model used for parameter estimation deviates from the underlying biology. The purpose of this study was to characterize the effects of motion and model bias within the context of a behavioral task challenge, examining the impacts of different mitigation strategies. Seventy healthy adults were administered bolus plus constant infusion RAC during a simultaneous PET/magnetic resonance (MR) scan with a reward task experiment. BPND and ΔBPND were estimated using an extension of the Multilinear Reference Tissue Model (E-MRTM2) and a new method (DE-MRTM2) was proposed to selectively discount the contribution of the initial uptake period. Motion was effectively corrected with a standard frame-based approach, which performed equivalently to a more complex reconstruction-based approach. DE-MRTM2 produced estimates of ΔBPND in putamen and nucleus accumbens that were significantly different from those estimated from E-MRTM2, while also decoupling ΔBPND values from first-pass k2' estimation and removing skew in the spatial bias distribution of parametric ΔBPND estimates within the striatum.

Heterogeneous price adjustments among Airbnb hosts amid COVID-19: Evidence from Barcelona.

COVID-19-induced travel restrictions have led to a sharp drop in Airbnb bookings. Confronted with a decrease in demand, hosts have implemented heterogeneous price responses. This study evaluates the different price adjustments developed by professional and non-professional hosts. Considering the city of Barcelona as the case study, I exploit monthly longitudinal data for 24,000 different Airbnb listings observed between June 2020 and April 2021. Using hedonic regressions with listing and neighbourhood fixed effects, I show that professional hosts have reduced prices to a greater extent, especially during the worst months of the pandemic. The findings support intertemporal price discrimination among professional hosts, which seem to adjust prices faster to meet demand and better adapt to market conditions.

A prion accelerates proliferation at the expense of lifespan.

In fluctuating environments, switching between different growth strategies, such as those affecting cell size and proliferation, can be advantageous to an organism. Trade-offs arise, however. Mechanisms that aberrantly increase cell size or proliferation-such as mutations or chemicals that interfere with growth regulatory pathways-can also shorten lifespan. Here we report a natural example of how the interplay between growth and lifespan can be epigenetically controlled. We find that a highly conserved RNA-modifying enzyme, the pseudouridine synthase Pus4/TruB, can act as a prion, endowing yeast with greater proliferation rates at the cost of a shortened lifespan. Cells harboring the prion grow larger and exhibit altered protein synthesis. This epigenetic state, [BIG+] (better in growth), allows cells to heritably yet reversibly alter their translational program, leading to the differential synthesis of dozens of proteins, including many that regulate proliferation and aging. Our data reveal a new role for prion-based control of an RNA-modifying enzyme in driving heritable epigenetic states that transform cell growth and survival.

Cells make different proteins to perform different tasks. Each protein is a long chain of building blocks called amino acids that must fold into a particular shape before it can be useful. Some proteins can fold in more than one way, a normal form and a 'prion' form. Prions are unusual in that they can force normally folded proteins with the same amino acid sequence as them to refold into new prions. This means that a single prion can make many more that are inherited when cells divide. Some prions can cause disease, but others may be beneficial. Pus4 is a yeast protein that is typically involved in modifying ribonucleic acids, molecules that help translate genetic information into new proteins. Sometimes Pus4 can adopt a beneficial prion conformation called [BIG⁺]. When yeast cells have access to plenty of nutrients, [BIG⁺] helps them grow faster and larger, but this comes at the cost of a shorter lifespan. Garcia, Campbell et al. combined computational modeling and experiments in baker's yeast (Saccharomyces cerevisiae) to investigate the role of [BIG⁺]. They found that the prion accelerated protein production, leading to both faster growth and a shorter lifespan in these cells, even without any changes in gene sequence. Garcia, Campbell et al.'s findings explain the beneficial activity of prion proteins in baker's yeast cells. The results also describe how cells balance a tradeoff between growth and lifespan without any changes in the genome. This helps to highlight that genetics do not always explain the behaviors of cells, and further methods are needed to better understand cell biology.

Healthy aging determinants and disability among older adults: SABE Colombia.

OBJECTIVE: To identify the main factors associated with disability in older adults in Colombia, adjusted according to structural and intermediary determinants of healthy aging. METHODS: This study used cross-sectional data from 23 694 adults over 60 years of age in the SABE Colombia nationwide survey. Structural determinants such as demographic and socioeconomic position variables were analyzed. Intermediary variables were classified into three blocks: intrinsic capacity, physical and built environment, and health care systems. Data analysis employed multivariate logistic regression. RESULTS: The prevalence of overall disability was 21% for activities of daily living, 38% for instrumental activities of daily living, and 33% for mobility disability. Disability was associated with sociodemographic structural determinants such as older age, female sex, rural residence, never married/divorced, living alone, low educational level, and Indigenous/Black ethnicity. With regard to determinants of socioeconomic position, net low income, poor socioeconomic stratum, insufficient income perception, and a subsidized health insurance scheme exerted a major influence on disability. Intermediary determinants of intrinsic capacity, such as poor self-rated health, multimorbidity, low grip strength, sedentary lifestyle, early childhood economic adversity, no social support, and no participation in activities, were significantly associated with disability. CONCLUSIONS: Actions that affect the main factors associated with disability, such as reducing health inequities through policies, strategies, and activities, can contribute significantly to the well-being and quality of life of Colombian older adults.

Health promotion interventions for African Americans delivered in U.S. barbershops and hair salons- a systematic review.

BACKGROUND: African American adults suffer disproportionately from obesity-related chronic diseases, particularly at younger ages. In order to close the gap in these health disparities, efforts to develop and test culturally appropriate interventions are critical. METHODS: A PRISMA-guided systematic review was conducted to identify and critically evaluate health promotion interventions for African Americans delivered in barbershops and hair salons. Subject headings and keywords used to search for synonyms of 'barbershops,' 'hair salons,' and 'African Americans' identified all relevant articles (from inception onwards) from six databases: Academic Search Ultimate, Cumulative Index of Nursing and Allied Health Literature (CINAHL), Embase, PsycINFO, PubMed, Web of Science (Science Citation Index and Social Sciences Citation Index). Experimental and quasi-experimental studies for adult (> 18 years) African Americans delivered in barbershops and hair salons that evaluated interventions focused on risk reduction/management of obesity-related chronic disease: cardiovascular disease, cancer, and type 2 diabetes were included. Analyses were conducted in 2020. RESULTS: Fourteen studies met criteria for inclusion. Ten studies hosted interventions in a barbershop setting while four took place in hair salons. There was substantial variability among interventions and outcomes with cancer the most commonly studied disease state (n = 7; 50%), followed by hypertension (n = 5; 35.7%). Most reported outcomes were focused on behavior change (n = 10) with only four studies reporting clinical outcomes. CONCLUSIONS: Health promotion interventions delivered in barbershops/hair salons show promise for meeting cancer screening recommendations and managing hypertension in African Americans. More studies are needed that focus on diabetes and obesity and utilize the hair salon as a site for intervention delivery. TRIAL REGISTRATION: PROSPERO CRD42020159050 .

Healthy aging determinants and disability among older adults: SABE Colombia

[ABSTRACT]. Objective. To identify the main factors associated with disability in older adults in Colombia, adjusted accord-ing to structural and intermediary determinants of healthy aging.Methods. This study used cross-sectional data from 23 694 adults over 60 years of age in the SABE Colombia nationwide survey. Structural determinants such as demographic and socioeconomic position variables were analyzed. Intermediary variables were classified into three blocks: intrinsic capacity, physical and built envi-ronment, and health care systems. Data analysis employed multivariate logistic regression.Results. The prevalence of overall disability was 21% for activities of daily living, 38% for instrumental activi-ties of daily living, and 33% for mobility disability. Disability was associated with sociodemographic structural determinants such as older age, female sex, rural residence, never married/divorced, living alone, low edu-cational level, and Indigenous/Black ethnicity. With regard to determinants of socioeconomic position, net low income, poor socioeconomic stratum, insufficient income perception, and a subsidized health insurance scheme exerted a major influence on disability. Intermediary determinants of intrinsic capacity, such as poor self-rated health, multimorbidity, low grip strength, sedentary lifestyle, early childhood economic adversity, no social support, and no participation in activities, were significantly associated with disability.Conclusions. Actions that affect the main factors associated with disability, such as reducing health inequities through policies, strategies, and activities, can contribute significantly to the well-being and quality of life of Colombian older adults.

[RESUMEN]. Objetivo. Determinar los principales factores asociados con la discapacidad en personas mayores en Colom-bia, ajustados según determinantes estructurales e intermediarios del envejecimiento saludable.Métodos. Este estudio empleó datos transversales de 23 694 adultos de más de 60 años provenientes de la encuesta nacional Colombia SABE. Se analizaron los determinantes estructurales como las variables demográficas y de situación socioeconómica. Las variables intermediarias se clasificaron en tres bloques: capacidad intrínseca, entorno físico y construido, y sistemas de atención de salud. El análisis de datos empleó la regresión logística con múltiples variables.Resultados. La prevalencia de la discapacidad general fue de 21% en la actividad cotidiana, 38% en la activi-dad cotidiana instrumental y 33% en la discapacidad relacionada con la movilidad. Se asoció la discapacidad con los determinantes estructurales sociodemográficos, como edad avanzada, sexo femenino, residencia en entornos rurales, estar soltero o divorciado, vivir solo, un nivel educativo bajo y tener etnicidad indígena o negra. Con respecto a los determinantes relativos a la situación socioeconómica, la principal influencia en la discapacidad fueron los ingresos netos bajos, la situación socioeconómica baja, una percepción insuficiente de ingresos y un plan de seguro de salud subsidiado. Los determinantes intermediarios de la capacidad intrínseca, como la mala salud informada por la propia persona, la multimorbilidad, la poca fuerza en el puño, un estilo de vida sedentario, las adversidades económicas desde la primera infancia, la carencia de apoyo social y la falta de participación en actividades se asociaron de manera significativa con la discapacidad.Conclusiones. Las medidas que tienen un efecto sobre los principales factores asociados con la discapaci-dad, como la reducción de las inequidades en materia de salud, mediante políticas, estrategias y actividades, pueden contribuir significativamente al bienestar y la calidad de vida de las personas mayores colombianas.

[RESUMO]. Objetivo. Identificar os principais fatores associados à incapacidade em idosos na Colômbia, ajustados de acordo com os determinantes estruturais e intermediários do envelhecimento saudável.Métodos. Este estudo usou dados transversais de 23.694 adultos com mais de 60 anos de idade que partic-iparam da pesquisa nacional SABE Colômbia. Determinantes estruturais, como variáveis demográficas e de condição socioeconômica, foram analisados. As variáveis intermediárias foram classificadas em três blocos: capacidade intrínseca, ambiente físico e construído, e sistemas de saúde. A análise dos dados empregou regressão logística multivariada.Resultados. A prevalência de incapacidade em geral foi de 21% para as atividades da vida diária, 38% para atividades instrumentais da vida diária e 33% para restrição de mobilidade. Constatou-se associação da incapacidade com determinantes estruturais sociodemográficos, como idade avançada, sexo feminino, residência em área rural, estado civil solteiro ou divorciado, viver sozinho, baixa escolaridade e etnia indígena/negra. Com relação aos determinantes da condição socioeconômica, baixa renda líquida, pertencimento ao estrato socioeconômico mais pobre, percepção de renda insuficiente e ter um plano de seguro-saúde sub-sidiado exerceram grande influência sobre a incapacidade. Determinantes intermediários da capacidade intrínseca, como autopercepção de saúde ruim, multimorbidade, força de preensão reduzida, estilo de vida sedentário, adversidade econômica na primeira infância, ausência de suporte social e não participação em atividades foram significativamente associados à incapacidade.Conclusões. Ações que afetem os principais fatores associados à incapacidade, como a redução das iniq-uidades em saúde por meio de políticas, estratégias e atividades, podem contribuir significativamente para o bem-estar e a qualidade de vida dos idosos colombianos.

The burden of skeletal-related events in four Latin American countries: Argentina, Brazil, Colombia, and Mexico.

AIM: Skeletal-related events (SREs) are major bone complications that frequently occur in patients with solid tumors (ST) and bone metastases, and in patients with multiple myeloma (MM). SREs include pathological fracture, spinal cord compression, radiation to bone, and surgery to bone. Limited data are available regarding the burden of SREs in Latin America. We built an economic model to quantify the current and future economic burden of SREs among adults in four Latin American countries: Argentina, Brazil, Colombia, and Mexico. METHODS: A comprehensive literature review with a systematic search strategy was conducted to parameterize the economic burden of illness (BOI) model. Economic analyses were conducted using a prevalence-based model. Aggregate SRE costs obtained from country-specific sources were used. We also included patient productivity losses. Costs were expressed in 2020 USD for the total annual burden, annual burden per 1,000 at risk, and projected five-year burden. RESULTS: The estimated total number of SREs was 251,503 in 2020, amounting to a total annual cost of USD 1.4 billion. The total projected five-year cost was USD 6.9 billion. Annual costs were highest in Brazil (USD 779.1 million), followed by Mexico (USD 281.8 million), Argentina (USD 174.6 million), and Colombia (USD 120.1 million). The average financial burden per 1,000 at risk was greatest in Brazil (USD 3.6 million), followed by Mexico (USD 3.4 million), Colombia (USD 2.9 million), and Argentina (USD 2.7 million). CONCLUSION: Despite recommendations by medical societies for the use of bone-targeted agents in patients with solid tumors and bone metastasis or with multiple myeloma and bone lesions, a large proportion of patients at risk of experiencing SREs are not treated. Early detection of bone metastases and SREs and the use of the most effective preventative treatments are needed to decrease the clinical and economic burden of SREs in Latin America.