Patterns of ocular trauma in elderly patients in an urban population-the Bronx experience / Padrões de trauma ocular em pacientes idosos em uma população urbana - a experiência de Bronx

ABSTRACT Purpose: To evaluate the characteristics of ocular injuries among elderly patients admitted to an urban level I trauma center because of major trauma from 2008 to 2015. Methods: A retrospective chart review was conducted of patients aged >65 years admitted with ocular injuries that were identified with ICD-9 codes. Tabulated data were analyzed using the Student's paired t-test, the chi-squared test, and regression analysis using STATA/MP-12 software. Significance was set at p<0.05. Results: Of a total of 861 patients, 221 (25.7%) admitted for major trauma and ocular injuries were elderly. The mean age of these patients was 80.3 years (median =79.2 years; interquartile range=63.8-94.6 years). Of these patients, 40.7% were males and 59.3% were females. The males were younger than the females (mean age, 77.3 vs. 82.4 years, respectively, p<0.001). Race was documented as white (30.8%), black (13.6%), and "other" (54.3%), with 67.5% of the "other" group (36.7% overall) identified as Hispanic. The most frequent injuries were contusion of the eye/adnexa (68.2%), orbital wall fractures (22.2%), and an open wound of the ocular adnexa (18.1%). Males had a 2.64-fold greater risk of orbital wall fractures (95% confidence interval [CI]=1.38-5.05, p<0.003). Patients with orbital wall fractures had higher injury severity scores than those without (95% CI=14.1-20.9 vs. 6.8-8.6, respectively, p<0.001). The most common injuries were falls (77.8%) and pedestrian/motor vehicle accidents (6.8%). Falls occurred mostly at home (51.7%), on the street (13.9%), and in hospitals/nursing homes (12.2%). Those falling at home were older than those falling at other locations (95% CI=81.8-85.4 vs. 77.0-80.6 years, respectively, p<0.002). Conclusions: Ocular injuries in elderly Bronx patients most commonly occurred in females due to falls in the home/nursing home setting. Public health measures addressing identifiable individual and environmental risks in these common locations would be most beneficial in reducing the incidence of ocular injuries in this population.

RESUMO Objetivo: Avaliar as características das lesões oculares de idosos nas internações por grandes traumatismos em um centro urbano de trauma nível I de 2008 a 2015. Métodos: Realizou-se uma revisão retrospectiva de prontuários de pacientes com mais de 65 anos internados com lesões oculares identificados com os códigos CID-9. Os dados tabulados foram analisados com o teste t de Student, teste qui-quadrado e análise de regressão, utilizando o software STATA/MP-12. A significância estatística foi fixada em p<0,05. Resultados: Duzentos e vinte e um (25,7%) pacientes de um total de 861, admitidos por traumatismo craniano importante e lesões oculares, eram idosos. A idade média era de 80,3 anos (mediana=79,2; intervalo interquartil=63,8-94,6). 40,7% eram do sexo masculino e 59,3% do feminino. Os homens eram menos idosos (média=77,3) do que as mulheres (média=82,4), p<0,001. A raça foi documentada como branca (30,8%), negra (13,6%) e "outra" (54,3%); 67,5% dos "outros" (36,7% no geral) identificados como hispânicos. As lesões mais frequentes foram contusão do olho/anexos (68,2%), fraturas da parede orbital (22,2%) e ferida aberta dos anexos oculares (18,1%). Os homens tiveram 2,64 mais chances de fraturas da parede orbital (95% CI=1,38-5,05; p<0,003). Pacientes com fraturas da parede orbital tiveram maiores escores de gravidade da lesão (95% CI=14,1-20,9) do que aqueles sem fraturas (96% IC=6,8-8,6), p<0,001. Os mecanismos comuns foram quedas (77,8%) e acidentes a pé com veículos automotores (6,8%). As quedas ocorreram principal mente em casa (51,7%), na rua (13,9%) e em hospitais/lares de idosos (12,2%). Aqueles que caíram em casa eram mais velhos (IC 95%=81,8-85,4) do que os que tiveram quedas em outros locais (IC 95%=77,0-80,6), p<0,002. Conclusões: Lesões oculares em pacientes idosos de Bronx foram mais comuns no sexo feminino e devido a quedas que ocorreram em casa/lar de idosos. Medidas de saúde pública direcionadas a riscos individuais e ambientais identificáveis nesses locais comuns seriam mais benéficas na redução de lesões oculares nessa população.

A abordagem da sexualidade como aspecto essencial da atenção integral de pessoas com transtornos mentais / The inclusion of sexuality as an essential aspect of comprehensive care for individuals with mental disorders

Resumo O estudo teve o objetivo de compreender as representações de usuários e de profissionais de serviços de saúde mental acerca da sexualidade dos primeiros. Entrevistaram-se individualmente 39 usuários e 54 profissionais de serviços públicos de saúde mental por meio de seis grupos focais. A análise dos dados fundamentou-se na Análise Estrutural de Narração. Pessoas com transtornos mentais (PTM) não representam saúde sexual como direito e encontram dificuldades para se cuidarem em face de estereótipos de gênero e pelo contexto de exclusão e pobreza. Entre os profissionais, as representações foram de negação da sexualidade das PTM, entendendo-a como “fora do normal” e que deve ser reprimida. Diálogos sobre sexualidade com os usuários são quase inexistentes. Os profissionais não estão preparados para assistência integral, o que requer capacitação permanente nos serviços e inclusão do tema na formação básica nas carreiras da área da saúde, de forma interdisciplinar.

Abstract The scope of this study was to understand the representations of mental health service patients and professionals concerning the sexuality of the former. Thirty-nine patients and 54 professionals of the public mental health services, divided up into six focal groups, were interviewed individually. Data analysis was based on the Structural Analysis of Narrative technique. Individuals with mental disorders do not perceive sexual health as a right and have difficulty taking care of themselves in the face of gender stereotypes, and for the contexts related with exclusion and poverty. Among the mental health service professionals, sexuality negation of mentally-ill individuals had been the commom representation. They classify this behavior as “not a normal representation” and believe that it must be restrained. Dialogues about sexuality with users are almost inexistent. Mental health service professionals are not prepared for integral assistance, which requires permanent qualification and the inclusion of this subject in the fundamental formation of health related careers, in a interdisciplinary way.

Vitamin D deficiency is independently associated with mortality among critically ill patients

OBJECTIVE: Studies suggest an association between vitamin D deficiency and morbidity/mortality in critically ill patients. Several issues remain unexplained, including which vitamin D levels are related to morbidity and mortality and the relevance of vitamin D kinetics to clinical outcomes. We conducted this study to address the association of baseline vitamin D levels and vitamin D kinetics with morbidity and mortality in critically ill patients. METHOD: In 135 intensive care unit (ICU) patients, vitamin D was prospectively measured on admission and weekly until discharge from the ICU. The following outcomes of interest were analyzed: 28-day mortality, mechanical ventilation, length of stay, infection rate, and culture positivity. RESULTS: Mortality rates were higher among patients with vitamin D levels <12 ng/mL (versus vitamin D levels >12 ng/mL) (32.2% vs. 13.2%), with an adjusted relative risk of 2.2 (95% CI 1.07-4.54; p< 0.05). There were no differences in the length of stay, ventilation requirements, infection rate, or culture positivity. CONCLUSIONS: This study suggests that low vitamin D levels on ICU admission are an independent risk factor for mortality in critically ill patients. Low vitamin D levels at ICU admission may have a causal relationship with mortality and may serve as an indicator for vitamin D replacement among critically ill patients. .

Lifespan extension and increased resistance to environmental stressors by N-Acetyl-L-Cysteine in Caenorhabditis elegans

OBJECTIVE: This study was performed to determine the effect of N-acetyl-L-cysteine, a modified sulfur-containing amino acid that acts as a strong cellular antioxidant, on the response to environmental stressors and on aging in C. elegans. METHOD: The survival of worms under oxidative stress conditions induced by paraquat was evaluated with and without in vivo N-acetyl-L-cysteine treatment. The effect of N-acetyl-L-cysteine on the response to other environmental stressors, including heat stress and ultraviolet irradiation (UV), was also monitored. To investigate the effect on aging, we examined changes in lifespan, fertility, and expression of age-related biomarkers in C. elegans after N-acetyl-L-cysteine treatment. RESULTS: Dietary N-acetyl-L-cysteine supplementation significantly increased resistance to oxidative stress, heat stress, and UV irradiation in C. elegans. In addition, N-acetyl-L-cysteine supplementation significantly extended both the mean and maximum lifespan of C. elegans. The mean lifespan was extended by up to 30.5% with 5 mM N-acetyl-L-cysteine treatment, and the maximum lifespan was increased by 8 days. N-acetyl-L-cysteine supplementation also increased the total number of progeny produced and extended the gravid period of C. elegans. The green fluorescent protein reporter assay revealed that expression of the stress-responsive genes, sod-3 and hsp-16.2, increased significantly following N-acetyl-L-cysteine treatment. CONCLUSION: N-acetyl-L-cysteine supplementation confers a longevity phenotype in C. elegans, possibly through increased resistance to environmental stressors. .

Prevalência de relação sexual e fatores associados em adolescentes escolares de Goiânia, Goiás, Brasil / Prevalence of sexual intercourse and associated factors among adolescents attending schools in Goiânia in the state of Goiás, Brazil

Objetivou-se investigar a prevalência de relação sexual em adolescentes de um município brasileiro e sua associação com fatores sociodemográficos, comportamentos de risco à saúde e percepção da imagem corporal. Estudo transversal utilizando dados da Pesquisa Nacional de Saúde do Escolar - PeNSE realizada em 2009. A amostra foi composta por escolares do 9° ano de Goiânia, Goiás (n = 3.099), com predomínio das idades de 13 a 15 anos. A variável dependente foi o relato de relação sexual alguma vez. Para identificação das variáveis associadas foi realizada análise de regressão de Poisson. A prevalência de relação sexual alguma vez foi de 26,5% (IC95% = 23,8-29,4). Este comportamento foi mais prevalente em adolescentes do sexo masculino, com idade de 14 anos ou mais, que não moravam com a mãe ou com o pai, estudavam em escolas públicas, relataram ter experimentado álcool, tabaco e outras drogas, e envolvimento em brigas e agressão familiar. Conclui-se que a prevalência de relação sexual alguma vez foi elevada e associada a condições sociodemográficas mais precárias, comportamentos de risco à saúde e violência. Estes fatores devem ser considerados nas estratégias de promoção de saúde, visando comportamentos sexuais seguros e saudáveis na adolescência.

This study sought to investigate the prevalence of sexual intercourse among adolescents in a Brazilian city and its association with sociodemographic factors, health-risk behaviors, and body image perception. A cross-sectional study was conducted using data from the National Adolescent School-based Health Survey (PeNSE), carried out in 2009. The sample comprised schoolchildren enrolled in the 9th year in the city of Goiânia, Goiás (n= 3,099), mostly aged between 13 and 15. The dependent variable was the reporting of sexual intercourse at least once. To identify variables associated with sexual activity, Poisson regression analysis was used. The prevalence of sexual intercourse at least once in the adolescents' lifetime was 26.5% (95% CI= 23.8-29.4). Prevalence was higher among males, those aged 14 years or older, who reported not living with their mother or with their father, who attended public schools, reported alcohol, tobacco or other drug use, and were involved in fights and family violence. The conclusion reached was that the prevalence of sexual intercourse was high and associated with poor sociodemographic conditions, health-risk behaviors and violence. These factors should be considered in the health promotion strategies seeking more safe and healthy sexual behavior during adolescence.

Epidemiología de las consultas respiratorias de adultos en Santiago de Chile desde 2003 a 2008 / Primary care consultations due to respiratory diseases in the period 2003-2008

Background: Respiratory diseases are the third cause of death, and the second cause of hospitalization among people aged 65 years or more in Chile. Aim: To analyze the distribution of consultations due to respiratory diseases among adults living in Metropolitan Santiago. Material and Methods: A daily registry of all consultations of patients older than 15 years old in seven public primary care centers, was carried out between January 2003 and December 2008. Consultations were classified as having non-respiratory or respiratory causes. The latter were broke down in upper or lower respiratory diseases, pneumonia, chronic obstructive pulmonary disease (COPD) and asthma. Results: A total of 1,170,941 consultations were registered and 19% were due to respiratory diseases. Of these, 46% were due to upper respiratory diseases, 31% due to lower respiratory diseases, 8% due to COPD, 6% due to pneumonia, 5% due to asthma and 4% due to other respiratory causes. Pneumonia and COPD were more frequent among consultants older than 65 years. Conclusions: Consultations due to respiratory diseases are approximately one fifth of all primary care consultations. Older people often have more chronic and severe diseases.

Psychometric Properties of a Measure Assessing Attitudes and Norms as Determinants of Intention to Use Oral Contraceptives

PURPOSE: Asian immigrant and Asian American women are less likely to use oral contraceptives (OCs) and tend to rely on low-efficacy methods of contraception. This contraceptive pattern remains poorly understood, in part, because no theory-driven measurement exists to assess psychosocial determinants essential in explaining behaviors related to OC use in this population. The current study aimed to evaluate the psychometric properties of a measure of attitudes and subjective norms toward OC use among Korean American women as a first step to determine whether the measure can be used in this population and, potentially, in other Asian ethnic groups. METHODS: The sample consisted of 329 Korean immigrant women living in New York City. The theory of reasoned action guided the development of the measure assessing attitudes and norms. Psychometric evaluation included item analysis, internal consistency estimates of reliability, and construct validity (i.e., factorial, discriminant, and predictive). RESULTS: All item-total correlations were above the recommendation of .30. The Cronbach's alpha for the attitudes and subjective norms measure was .88 and .86, respectively. Exploratory factor analyses revealed four interpretable factors, and confirmatory factor analyses confirmed that the factor structures derived from the exploratory factor analyses fit the data well. Discriminant and predictive validity of the measure were also established. CONCLUSIONS: The study provides support for the validity and reliability of the measure and its use for determining the degree to which Korean immigrant women intend to use OCs.

Screening Colonoscopy among Uninsured and Underinsured Urban Minorities

BACKGROUND/AIMS: Uninsured individuals have lower rates of screening colonoscopy (SC), and little is known regarding the pathology results obtained when they undergo colonoscopies. Since 2004, we have participated in a program that offers SC to uninsured New Yorkers; herein, we report our findings. METHODS: Uninsured, average-risk patients who were at least 50 years of age underwent SC at our institution between April 2004 and June 2011. We analyzed polyp pathology, location, size, incidence of adenomas, and incidence of adenomas with advanced pathology (AAP) with respect to ethnicity, gender, and age. RESULTS: Out of 493 referrals, 222 patients completed the colonoscopies. Polyps were identified in 21.2% of all patients; 14% had adenomas, and 4.5% had AAP. The rates of adenomas among African-Americans, Hispanics, and Whites were 24.3%, 12.1%, and 11.6%, respectively, and the corresponding rates of AAP were 10.8%, 3.5%, and 2.3%. Differences in the polyp type, location, and AAP did not reach statistical significance with respect to ethnicity or gender. Patients aged 60 and older were found to have a higher rate of advanced adenomas compared with younger patients (8.6% vs 2.6%, p=0.047). CONCLUSIONS: Further efforts to fund screening colonoscopies for uninsured individuals will likely result in the identification of advanced lesions of the colon before they progress to colorectal cancer.

The practice of nurses caring for families of pediatric inpatients in light of Jean Watson / La práctica del cuidado del enfermero com famílias de niños según jean watson / A prática do cuidado do enfermeiro com famílias de criança à luz de Jean Watson

Objective To know the facilities and the difficulties of nurses in caring practice of hospitalized children’s families in the light of Jean Watson’s Theory of Human Caring. Method It was used the descriptive qualitative approach. The data collection was conducted in three stages: presentation of theoretical content; engagement with families in the light of Watson’s theory; and semi-structured interview with 12 pediatric nurses. The interviews were analysed using inductive thematic analysis, being possible to form three themes: Recognizing a framework for care; Considering the institutional context; and Challenges in family’s relationship. Results The theory favored reflections about self, about the institutions and about nurses’ relationship with the family of the child, normalized by a consciousness toward caring attitudes. Conclusion In this process, it is imperative that nurses recognize the philosophical-theoretical foundations of care to attend the child’s family in hospital.

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Objetivo Analizar la violencia contra los adolescentes a la luz de las categorías de género y generación. Método It was used the descriptive qualitative approach. The data collection was conducted in three stages: presentation of theoretical content; engagement with families in the light of Watson’s theory; and semi-structured interview with 12 pediatric nurses. The interviews were analysed using inductive thematic analysis, being possible to form three themes: Recognizing a framework for care; Considering the institutional context; and Challenges in family’s relationship. Resultados The theory favored reflections about self, about the institutions and about nurses’ relationship with the family of the child, normalized by a consciousness toward caring attitudes. Conclusión In this process, it is imperative that nurses recognize the philosophical-theoretical foundations of care to attend the child’s family in hospital.

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Objetivo Conhecer as facilidades e as dificuldades do enfermeiro na prática do cuidado das famílias de crianças internadas, à luz da Teoria do Cuidado Humano de Jean Watson. Método Utilizou a abordagem qualitativa descritiva. A coleta dos dados foi realizada em três etapas: apresentação do conteúdo teórico; engajamento com as famílias à luz da teoria de Watson; e entrevista semiestruturada com 12 enfermeiras de pediatria. As entrevistas foram submetidas à análise temática indutiva, sendo possível formar três temas: Reconhecendo um referencial para o cuidado; Considerando o contexto institucional; e Desafios no relacionamento com a família. Resultados A teoria favoreceu reflexões sobre o self, sobre as instituições e sobre o relacionamento com a família da criança, normalizadas por uma consciência voltada para atitudes de cuidado. Conclusão Nesse processo, é imperativo que o enfermeiro reconheça os fundamentos teórico-filosóficos do cuidado para atender à família da criança no hospital.
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Cómo aumentar la actividad física de los niños durante el período del recreo en las escuelas / Increasing children's physical activity during school recess periods

OBJETIVOS: Analizamos si la participación de las escuelas en el Programa de Mejoramiento del Recreo (PMR) en la primavera del año 2011 estuvo asociada a tasas más altas de actividad física intensa en los niños. MÉTODOS: En el PMR, un coordinador dirige a los niños para que practiquen juegos adecuados para la edad a fin de aumentar su nivel de actividad física. Durante el recreo en 25 escuelas primarias públicas de la ciudad de Nueva York (15 participantes en el PMR, 10 no participantes en el PMR) los investigadores observaron algunas áreas predeterminadas (n = 1 339 observaciones) y registraron el número de niños que estaban sedentarios, caminando o muy activos. RESULTADOS: Tras el análisis estadístico con múltiples variables se encontró que la participación en el PMR era una variable predictiva significativa (P = 0,027) de la tasa de actividad física intensa (porcentaje de niños muy activos en las áreas de observación) cuyas medias de los mínimos cuadrados fueron de 41% en las escuelas participantes en el PMR y de 27% en escuelas no participantes en el PMR. En las escuelas participantes en el PMR se siguió registrando una tasa significativamente superior incluso cuando el coordinador de juegos no estaba en el área de observación, lo que sugiere un cambio en la cultura del recreo en las escuelas que participan en este programa. CONCLUSIONES: La tasa de actividad física intensa en las escuelas participantes en el PMR fue 14 puntos porcentuales (o 52%) superior a la tasa registrada en las escuelas no participantes en el PMR. Esta intervención de bajo costo podría ser un agregado valioso a las herramientas para combatir la obesidad infantil y podría valer la pena reproducirla en otros sitios.

OBJECTIVES: We examined whether schools' participation in the Recess Enhancement Program (REP) in the spring of 2011 was associated with higher rates of children's vigorous physical activity. METHODS: In REP, a coach guides children through age-appropriate games aimed at increasing their physical activity. During recess at 25 New York City public elementary schools (15 REP, 10 non-REP), researchers visually scanned predetermined areas (n = 1339 scans), recording the number of sedentary, walking, and very active children. RESULTS: Multivariate statistical analysis found that participation in REP was a significant predictor (P = .027) of the rate of vigorous physical activity (percentage very active in scan area) whose least-squares means were 41% in REP schools and 27% in non-REP schools. A significantly higher rate in REP schools persisted when the coach was not in the scan area, suggesting a change in the recess culture of REP schools. CONCLUSIONS: The rate of vigorous physical activity in REP schools was 14 percentage points, or 52%, higher than the rate in non-REP schools. This low-cost intervention might be a valuable addition to the tools for combating childhood obesity and worth replicating elsewhere.

Dietary Habits and Taste Preferences of the Korean Americans According to Self Body Image Perception and Length of Residence in US

BACKGROUND: Weight overestimation of Korean Americans may be associated with dietary habits and preferences for foods and tastes. METHODS: The subjects were 100 Korean Americans in New York City and LA and 100 Koreans in Seoul, who were 20-29 years old. Self-reported questionnaire consisted of age, height, weight, length of residence in US, preferences for 10 foods and 5 tastes, dietary habits and perception of self body image. Korean Americans were further divided into 3 groups according to length of residence in US. RESULTS: More Korean American women underestimated (27.3% vs. 5.8%), and less overestimated their body weights, than Korean women (31.8% vs. 53.8%, P=0.008). Korean Americans who overestimated their own body weights had significantly higher preference for salty taste and significantly lower dietary habit score regarding regular meals. CONCLUSIONS: Overestimation of self body size, rather than longer residence in US may be associated with the undesirable dietary habit and taste preference of Korean Americans, highlighting the importance of correct body image.

Five-Year Review of HIV-Hepatitis B Virus (HBV) Co-Infected Patients in a New York City AIDS Center

A retrospective review of 4,721 human immunodeficiency virus (HIV)-infected patients, followed at St. Luke's Roosevelt Hospital Center, New York City, was conducted from January 1, 2005 to December 31, 2009. HIV-Hepatitis B virus (HBV) co-infection rate was 218/4,721, 4.6%. Among co-infected patients, 19 patients (19/218, 8.7%) died; 13 patients (13/19, 68.4%) died from non-acquired immune deficiency syndrome (AIDS) defining including 2 patients with liver failure. More non-survivors (5 patients, 5/19, 26.3%) had liver cirrhosis than those who survived (8 patients, 8/199, 4.0%; P = 0.002). There were more patients with positive HBV e antigen (HBeAg) among non-survivors, (12 patients, 12/19, 63.2%) than among survivors (74 patients, 74/199, 37.2%; P = 0.047). HIV-HBV co-infection is associated with increased overall mortality. Therefore, use of dual active antiretrovirals, particularly, tenofovir (TDF) based regimen for optimal suppression of HIV-HBV and immune restoration with prevention of high risk behaviors may contribute to improved outcomes.

A Study on Body Image Perception and Eating Disorders by Birth-Place and the Length of Residence in USA in Korean American College Students / 대한지역사회영양학회지

This study was conducted to compare the body image perception, weight control experiences and the eating disorders according to where they were born, and the length of residence in USA among Korean-American college students. Three hundred college students participated in the study: 144 males and 156 females, 122 America-born (AB) and 171 Korea-born (KB) who live in New York City and New Jersey. Subjects responded to a self-administered questionnaire. The results showed that the ratio of overweight (23.2%) and obesity (26.8%) of males was higher than females' (16.1% and 6.3%, respectively). There were no significant differences according to born-place or the length of residence in USA of KB. People who had tried to control their weight were 58%. The ratio of weight control experiences of females (72.4%) was higher than males' (42.4%) as well as people who were normal or underweight than who were overweight or obesity. There were no significant differences according to born-place or the length of the residence in the USA of KB. In body image perception, the subjects who were normal and underweight overestimated their body figure, and the subjects who were overweight and obese underestimated their body figure. The desired and ideal figure of female students was significantly thinner than the current figure and also that of male students. There were no significant differences according to born-place or the length of the residence in USA of KB. The ratio of eating disorder was 8.7%, and females had higher percentage than males. And shorter they lived in USA, the percentage of eating disorder was higher.

Links between the built environment, climate and population health: interdisciplinary environmental change research in New York City

Global climate change is expected to pose increasing challenges for cities in the following decades, placing greater stress and impacts on multiple social and biophysical systems, including population health, coastal development, urban infrastructure, energy demand, and water supplies. Simultaneously, a strong global trend towards urbanisation of poverty exists, with increased challenges for urban populations and local governance to protect and sustain the wellbeing of growing cities. In the context of these 2 overarching trends, interdisciplinary research at the city scale is prioritised for understanding the social impacts of climate change and variability and for the evaluation of strategies in the built environment that might serve as adaptive responses to climate change. This article discusses 2 recent initiatives of The Earth Institute at Columbia University (EI) as examples of research that integrates the methods and objectives of several disciplines, including environmental health science and urban planning, to understand the potential public health impacts of global climate change and mitigative measures for the more localised effects of the urban heat island in the New York City metropolitan region. These efforts embody 2 distinct research approaches. The New York Climate & Health Project created a new integrated modeling system to assess the public health impacts of climate and land use change in the metropolitan region. The Cool City Project aims for more applied policy-oriented research that incorporates the local knowledge of community residents to understand the costs and benefits of interventions in the built environment that might serve to mitigate the harmful impacts of climate change and variability, and protect urban populations from health stressors associated with summertime heat. Both types of research are potentially useful for understanding the impacts of environmental change at the urban scale, the policies needed to address these challenges, and to train scholars capable of collaborative approaches across the social and biophysical sciences.

La mediación de la palabra hablada en la situación analítica: Reconocer como propio su componente afectivo / The transforming role of words in psychoanalytic practice

A partir del interés por conocer cómo las personas forman en su mente una representación de Dios, se aborda el tema de la representación psíquica. Se las considera procesos de memoria revisitables y transformables a partir de los encuentros con otros humanos. Acuciada por una paciente que repetía "lo que usted me dice no son más que palabras" y "ahorcada" en su propio instrumento se lanza a estudiar el tema de la palabra, y aborda la monografía de Freud sobre La afasia, de la época presicoanalítica, donde encuentra la subestructura de la conceptualización del lenguaje presente en la obra psicoanalítica de Freud. Se destaca la noción de palabra psíquica que se alcanza cuando la representación de palabra se conecta con la representación cosa. Se señalan las ideas de Freud acerca de que "El lenguaje está integrado en el cuerpo"[...]Se valoriza la palabra como sonido y afecto y esto lleva a plantear el espejo del sonido de la voz materna como una necesidad anterior a la de verse reflejado a través del espejo de la mirada materna winnicottiano.Se destaca como positivo la integración de las investigaciones provenientes de otros campos en el contexto transferencial y del proceso analítico

Sexual Behavior among Puerto Rican Adolescents

OBJECTIVE: The objective of this study is to compare the prevalence of several types of sexual behaviors among Puerto Rican adolescents living in New York City and in the Greater San Juan Metropolitan Area of Puerto Rico. BACKGROUND: There is a scarcity of literature about sexual behaviors among Hispanic adolescents. The available literature has several limitations. METHODS: The data for the analysis was collected through personal interviews in two high schools, one in Puerto Rico and the other in New York City as part of multi-site Centers for Disease Control (CDC) study. RESULTS: To test whether the adolescent sexual behavior varied by site and more specifically to determine whether the Puerto Rican youngsters surveyed in New York are more sexually experienced, as measured by a sexual involvement scale, a set-wise hierarchical multiple regression/correlation (MRC) analysis was done. It showed that the sexual involvement behavior of Puerto Rican students in N.Y. was higher that the involvement of students surveyed in Puerto Rico even when controlling by gender, age, mother's education and household composition. CONCLUSION: Variations in the sexual behavior of Puerto Rican adolescents living in two socio-cultural environments (New York City and Greater San Juan in Puerto Rico) were documented. Differences were observed both in the patterns of sexual experiences reported in the two sites in the higher levels of sexual experience reported in the New York sample. The documented differences have important implications for the development of interventions for HIV/STD prevention strategies.

Occupational exponsure to HIV in an urban university hospital setting

In response to the potential transmission of the human immunodeficiency virus in a hospital setting, an occupational exponsure assessment program was established at a New York City university hospital in 1990. During the first year, 322 potential exposures to blood or body secretions in 313 health care workers (HCWs)were reported. Exposures occurred most frequently on the surgical service (36 percent), and in patients' rooms (37 percent). Nurses accounted for 53 percent and physicians 25 percent of reported exposures. A percutaneous injury was reported by 78 percent of HCWs. Human error was responsible for the exposure in 54 percent of HCWs and was associated with a break in universal precautions in one-third. The immune status for HIV antibody, hepatitis B antigen and hepatitis C antibody was positive in 11 percent, 3 percent and 9 percent in source patients, respectively. However, the immune status for these potential nosocomially transmited pathogens was not determined in 12 percent and 26 percent of source patients. Based on the source patients HIV antibody status and the extent of injury, zidovudine was recommended to 39 HCWs; 12 refused prophylaxis. HIV seroconversion was not documented in those HCW who returned for follow-up testing. A similar assessment program for medical students rotating on the surgical service revealed that two-thirds were exposed to blood or body fluids while in the operating room. Only 16 percent of sharps injuries were self-inflicted, whereas 66 percent were caused by another HCWs, usally a surgical attending or houseofficer. These data underscore the necessity for institutional programs regarding management of HCWs potentially exposed to HIV. Such programs not only provide an indispensable service to the exposed HCW and medical student, but also a means by which infection control policies and educational programs may be monitored and implemented.