Mental Well-being InSciEd Out: Health Partnerships with the Boys & Girls Clubs of Puerto Rico.

BACKGROUND: Mental health care is a top clinical concern for modern Puerto Rico, especially given a dramatically changing economic landscape paired with recurrent natural disasters. Youth are particularly at-risk due to long-term impacts of toxic stress and adverse childhood experiences on health and development. OBJECTIVES: Here we present a novel clinician-community-educator-scientist partnership to address Puerto Rican youth mental well-being and wellness. We deployed pilot health workshops within the Boys & Girls Clubs of Puerto Rico to build youth mental health conceptual understanding and competencies in stress recognition and management. The work in progress herein evaluates acceptability and feasibility of our curricular model. METHODS: Dialogue with community stakeholders guided curricular design of workshops for youth ages 6 to 13 and older. Prior to implementation, educators and volunteers attended a 1-day training on educational strategies. Workshop success was evaluated using qualitative approaches (i.e., narrative feedback, educator and volunteer reflections, youth Talking Drawings) to assess youth engagement, youth conceptual health understanding, and educator/volunteer impressions of feasibility and impact. RESULTS: Initial findings indicate high acceptability and feasibility of our curricular model. Youth engagement and enthusiasm were noted in educator feedback and continue to be sustained post-workshop. Preliminary analysis shows accompanying increases in youth conceptual mental health understanding, particularly for 6- to 12-year-olds in recognition of stress and healthy coping mechanisms. Reciprocal gains were observed for volunteers. CONCLUSIONS: Activities have evolved into a formal partnership called Semilla, which features expanded analysis of mental well-being and wellness outcomes. Our collaborative model continues to engage Puerto Rican youth in the science of their well-being.

Decreasing Older Adult COVID-19 Risk Factors Using Digital Technology to Implement a Plant-Based-Diet: An Opinion Paper.

UNSTRUCTURED: A disproportionate number of COVID-19 cases affect older, minority populations. Obese older adults are at higher risk for severe COVID-19 complications and lower survival rates; minority older adults often experience higher rates of obesity. A plant-based diet intervention may improve COVID-19 obesity modifiable risk factors. Encouraging the consumption plant-based diets consisting of vegetables, fruits, whole grains, legumes, seeds, and nuts utilizing community outreach strategies and digital technology can contribute to improving COVID-19 risk factors.

Racial/Ethnic Differences in Those Accompanying Medicare Patients to the Doctor: Insights from the 2013 Medicare Current Beneficiary's Survey.

Surprisingly little current, population-level detail exists regarding companion accompaniment for health care among Medicare beneficiaries, particularly by race/ethnicity. For respondents in the 2013 Medicare Current Beneficiary's Survey Access to Care public use data (N = 12,253), multivariable models predicted accompaniment to the doctor by race/ethnicity, adjusting for confounders. Chi square analyses compared, by race/ethnicity, who was accompanying and why. Overall, 37.5% of beneficiaries had accompaniment. In multivariable analyses, non-Hispanic blacks (OR 1.18; 95% CI 1.03-1.36) and Hispanics (OR 1.47; 95% CI 1.25-1.74) were significantly more likely than non-Hispanic whites to have accompaniment. Over 35% of all three groups had someone to "take notes," "ask questions," and/or "explain things," which did not vary by race/ethnicity; significant differences were seen for "explain instructions," "translate," and "moral support." Hispanics had the highest percentages for all three. Many Medicare beneficiaries have accompaniment to doctors' appointments, particularly in minority racial/ethnic groups, which should be considered in policy and practice.

Building Bridges to Address Health Disparities in Puerto Rico: the "Salud para Piñones" Project.

Over the past several decades, Puerto Ricans have faced increased health threats from chronic diseases, particularly diabetes and hypertension. The patient-provider relationship is the main platform for individual disease management, whereas the community, as an agent of change for the community's health status, has been limited in its support of individual health. Likewise, traditional research approaches within communities have placed academic researchers at the center of the process, considering their knowledge was of greater value than that of the community. In this paradigm, the academic researcher frequently owns and controls the research process. The primary aim is contributing to the scientific knowledge, but not necessarily to improve the community's health status or empower communities for social change. In contrast, the community-based participatory research (CBPR) model brings community members and leaders together with researchers in a process that supports mutual learning and empowers the community to take a leadership role in its own health and well-being. This article describes the development of the community-campus partnership between the University of Puerto Rico School of Medicine and Piñones, a semi-rural community, and the resulting CBPR project: "Salud para Piñones". This project represents a collaborative effort to understand and address the community's health needs and health disparities based on the community's participation as keystone of the process. This participatory approach represents a valuable ally in the development of long-term community-academy partnerships, thus providing opportunities to establish relevant and effective ways to translate evidence-based interventions into concrete actions that impact the individual and community's wellbeing.

Access to medications for medicare enrollees related to race/ethnicity: Results from the 2013 Medicare Current Beneficiary Survey.

BACKGROUND: Prescription medications are taken by millions of Americans to manage chronic conditions and treat acute conditions. These medications, however, are not equally accessible to all. OBJECTIVE: To examine medication access by race/ethnicity among Medicare beneficiaries. METHODS: Using the 2013 Medicare Current Beneficiary Survey (n = 10.515), this study examined access to medications related to race/ethnicity, comparing non-Hispanic blacks and Hispanics to whites. Multivariable logistic regression models were estimated, controlling for age, gender, income, education, chronic conditions, and type of drug coverage. RESULTS: Non-Hispanic blacks were less satisfied than whites with amount paid for prescriptions [OR = 0.69,95%CI(0.55,0.86)], the list of drugs covered by their plan [OR = 0.69,95%CI(0.56,0.85)], and finding a pharmacy that accepts their drug coverage [OR = 0.59,95%CI(0.48,0.72)], after adjustment. Low-income individuals were more likely to report not filling a prescription and taking less medication than prescribed. Compared to beneficiaries with excellent health, those with poor, fair, or good health were less satisfied with access. Access was also diminished for patients with depression, diabetes, and chronic obstructive pulmonary disease, emphysema or asthma. CONCLUSION: Possible interventions for non-Hispanic blacks might include assisting them in finding the best drug plan to meeting their needs, connecting them to medication assistance programs, and discussing convenience of pharmacy with patients.

Translation in Data Mining to Advance Personalized Medicine for Health Equity.

Personalized medicine is the development of 'tailored' therapies that reflect traditional medical approaches, with the incorporation of the patient's unique genetic profile and the environmental basis of the disease. These individualized strategies encompass disease prevention, diagnosis, as well as treatment strategies. Today's healthcare workforce is faced with the availability of massive amounts of patient- and disease-related data. When mined effectively, these data will help produce more efficient and effective diagnoses and treatment, leading to better prognoses for patients at both the individual and population level. Designing preventive and therapeutic interventions for those patients who will benefit most while minimizing side effects and controlling healthcare costs, requires bringing diverse data sources together in an analytic paradigm. A resource to clinicians in the development and application of personalized medicine is largely facilitated, perhaps even driven, by the analysis of "big data". For example, the availability of clinical data warehouses is a significant resource for clinicians in practicing personalized medicine. These "big data" repositories can be queried by clinicians, using specific questions, with data used to gain an understanding of challenges in patient care and treatment. Health informaticians are critical partners to data analytics including the use of technological infrastructures and predictive data mining strategies to access data from multiple sources, assisting clinicians' interpretation of data and development of personalized, targeted therapy recommendations. In this paper, we look at the concept of personalized medicine, offering perspectives in four important, influencing topics: 1) the availability of 'big data' and the role of biomedical informatics in personalized medicine, 2) the need for interdisciplinary teams in the development and evaluation of personalized therapeutic approaches, and 3) the impact of electronic medical record systems and clinical data warehouses on the field of personalized medicine. In closing, we present our fourth perspective, an overview to some of the ethical concerns related to personalized medicine and health equity.

Incorporating translational research with clinical research to increase effectiveness in healthcare for better health.

BACKGROUND: The transfer of new scientific discoveries into healthcare interventions requires that basic and clinical researchers work together with health care providers to generate team science. These innovative models require translational teams, and need to extend beyond the academic environment. The future of translational science requires partnerships with the healthcare community as well as the broader, general community. This new integrated model of effective translational teams holds promise for addressing thorny and persistent health disparities, is consistent with the nation's strategic priority of eliminating health disparities, and bodes well for increasing healthcare effectiveness aimed at better health for all. DISCUSSION: As part of the 13th Research Centers in Minority Institutions (RCMI) International Symposium on Health Disparities, several senior academic leaders joined efforts to hold a workshop to discuss a model that considers the incorporation of two translational research strategies in research career development programs: Comparative effectiveness research (CER) and community-based participatory research (CBPR) for increasing healthcare effectiveness and eliminating healthcare disparities. Discussion included what issues may be most germane to the concept of a unified model for research workforce development through formal training and career development leading to increased effectiveness in healthcare for better health. SUMMARY: We believe that there is a gap in knowledge and skills in formal research career development programs that will enable physicians, other clinicians, and basic scientists to actively participate in these two translational research strategies. The purpose of this paper is to share the outcomes of these discussions, and encourage further discussion and possible innovation in the formulation of a new model for translational research workforce development.

A multiinstitutional, multidisciplinary model for developing and teaching translational research in health disparities.

Health disparities may affect any person in any community in the world, resulting from a multitude of factors including socioeconomic status, race, ethnicity, environment, and genetics. The impact of health disparities is felt by affected individuals, their families, communities, and the greater health care system. There is a critical need to increase health disparities research activities. This may be achieved by expanding and strengthening the training, education and career development of motivated clinicians, physicians and basic scientists, engaging them in clinical and translational research. Translational research relies on collaboration across disciplines, facilitating the dissemination and transfer of knowledge to populations for the overall improvement of health while decreasing the economic burden of health care. The University of Puerto Rico Medical Sciences Campus (UPR-MSC), Schools of Health Professions and Medicine joint initiatives, Clinical Research Education and Career Development (CRECD) and Hispanics in Research Capability (HiREC) programs, convened health disparities experts, faculty and scholars from multiple disciplines, cultural backgrounds and institutions. Together, they created a model for teaching translational research in health disparities that spans disciplines without boundaries.