Pacific Islands Cohort on Cardiometabolic Health Study: rationale and design.

BACKGROUND: Pacific Islanders, including those residing in the US Affiliated Pacific Islands (USAPI), experience some of the highest mortality rates resulting from non-communicable diseases (NCDs) worldwide. The Pacific Island Health Officers' Association declared a Regional State of Health Emergency in 2010 due to the epidemic of NCDs in the USAPI. Obesity, a known risk factor for NCDs, has become an epidemic among both children and adults in Micronesia and other parts of the USAPI. There is some recent information about overweight and obesity (OWOB) among young children in the USAPI, but there is no data looking at the relationship between children and their biological parents. The Pacific Islands Cohort on Cardiometabolic Health (PICCAH) Study aims to collect data on NCD lifestyle factors from two generations of families (n = 600 child-parent dyads or 1,200 participants) living in Guam, Pohnpei, and Palau. METHODS: The PICCAH Study is an epidemiological study using community-based convenience sampling to recruit participants in USAPI of Guam, Palau, and Pohnpei. The goal is to recruit participant dyads consisting of 1 child plus their biological parent in Guam (500 dyads or 1,000 participants), Pohnpei (50 dyads or 100 participants), and Palau (50 dyads or 100 participants). All participants are having the following information collected: demographic, health, and lifestyle information; anthropometry; diet; physical activity; sleep; acanthosis nigricans; blood pressure; and serum levels of fasting plasma glucose, fasting insulin, glycated hemoglobin, total cholesterol, triglycerides, LDL, and HDL. DISCUSSION: The PICCAH Study is designed to establish the baseline of a generational epidemiologic cohort with an emphasis on cardiometabolic risk, and to better understand the extent of DM and CVD conditions and related risk factors of those living in the USAPI jurisdictions of Guam, Pohnpei, and Palau. This study also serves to further build research capacity in the underserved USAPI Region.

Components of case management in caring for patients with dementia: a mixed-methods study.

BACKGROUND: Case management has shown improvements in some health outcomes for dementia patients and their families. However, despite its benefits the components of case management in order to provide effective patient and family care remain unknown at present. Thus, the aim of this study is to identify the specific components of case management in caring for patients with dementia and to determine the necessary intensity of its deployment to enhance outcomes for these patients and their caregivers. METHODS: Mixed-methods study with a qualitative phase to characterise forms of service provision, according to the case management components involved, followed by a quantitative phase to analyse the correlations between different patterns of service provision, adverse events in patients and caregiver overload. This study will be based on the variables described in the RANGE.COM register. DISCUSSION: This research is expected to achieve a reproducible, evaluable set of interventions that can be modelled to optimise case management effectiveness for patients with dementia. Interactions between patients with dementia, their family caregivers and case management healthcare services, the components of these interactions and their association with the conditions of the individuals concerned are issues of great interest in the field of case management, which is constantly evolving.

Rol de cuidadores migrantes de mayores dependientes y opinión de la asistencia sanitaria en atención primaria / Role of migrant caregivers of dependent elderly and opinion of health care in Primary Care

Objetivo: Describir el proceso de experiencias de vida de las personas migrantes que se convierten en cuidadores de mayores en situación de dependencia y conocer su opinión de la asistencia sanitaria. Diseño: Investigación cualitativa fenomenológica basada en la metodología de la teoría fundamentada. Realizado en el distrito sanitario Málaga-Guadalhorce durante 2017 y 2018. La captación se realizó mediante las enfermeras de familia de los centros de salud y a través de la base de datos de programas de atención domiciliaria de siete centros de salud. Se realizaron 17 entrevistas en profundidad a cuidadores migrantes que llevan cuidando un año o más a personas dependientes, hasta la saturación de la información. Resultados: En este estudio se han descrito tres fases: fase inicial, la persona siente la necesidad de cambio y motivación para venir; segunda fase, búsqueda de trabajo en nuestro país y asunción de nuevas actividades; tercera fase, estrategia de afrontamiento e incertidumbre por expectativas de futuro. Manifiestan mejoras en salud en relación con: tiempos reducidos de consulta, dificultad para ver especialistas, falta de regularidad en las visitas médicas en domicilio y discriminación sufrida por ser migrante. Conclusión: Los migrantes traen experiencia en el cuidado de sus diferentes culturas que deben ser exploradas. El refuerzo positivo de los empleadores, salarios y tiempo libre han sido condicionantes de mejora de satisfacción laboral y apoyo social. Lo mejor valorado del servicio sanitario son las visitas domiciliarias por el refuerzo positivo. Al mismo tiempo se quejan de que no reciben todas las que necesitan. Los profesionales deben realizar intervenciones en cada fase para facilitar la adopción de este rol, tratar de solucionar los problemas que surjan e informar a los organismos de salud de nuestra comunidad autónoma sobre dónde están los puntos débiles que deben mejorarse y de qué puntos fuertes partimos (AU)

Objective: To describe the process of life experiences of migrants who become caregivers of elderly people in situations of dependency and to know their opinion about health care. Design: Phenomenological qualitative research based on the methodology of grounded theory. Carried out in the Málaga-Guadalhorce health district, during 2017 and 2018. Recruitment was carried out by nurses from families in the Health Centers and through a database of home care programs, from seven health centers. 17 in-depth interviews were carried out with migrant caregivers, who have been caring for a year or more, dependent people, until the saturation of the information. Results: Three phases have been described in this study. In the initial stage the person feels the need for change and motivation to come; second stage of job search in our country and assume new activities; third stage of coping strategy and uncertainty for future expectations. They show improvements in health in relation to: reduced medical consultation time, it is difficult to consult with specialists, lack of regularity in home doctor visits and discrimination suffered by being a migrant. Conclusion: Migrants bring experience in caring for their different cultures that must be explored. The positive reinforcement of employers, salaries and free time have been conditions for improving job satisfaction and social support. What they value most in the health service are home visits for positive reinforcement, at the same time they complain that they do not receive all they need. Professionals should make interventions at each stage to facilitate the adoption of this role (AU)

Phenological records as a complement to aerobiological data.

Phenological studies in combination with aerobiological studies enable one to observe the relationship between the release of pollen and its presence in the atmosphere. To obtain a suitable comparison between the daily variation of airborne pollen concentrations and flowering, it is necessary for the level of accuracy of both sets of data to be as similar as possible. To analyse the correlation between locally observed flowering data and pollen counts in pollen traps in order to set pollen information forecasts, pollen was sampled using a Burkard volumetric pollen trap working continuously from May 1993. For the phenological study we selected the main pollen sources of the six pollen types most abundant in our area: Cupressaceae, Platanus, Quercus, Plantago, Olea, and Poaceae with a total of 35 species. We selected seven sites to register flowering or pollination, two with semi-natural vegetation, the rest being urban sites. The sites were visited weekly from March to June in 2007, and from January to June in 2008 and 2009. Pollen shedding was checked at each visit, and recorded as the percentage of flowers or microsporangia in that state. There was an association between flowering phenology and airborne pollen records for some of the pollen types (Platanus, Quercus, Olea and Plantago). Nevertheless, for the other types (Cupressaceae and Poaceae) the flowering and airborne pollen peaks did not coincide, with up to 1 week difference in phase. Some arguments are put forward in explanation of this phenomenon. Phenological studies have shown that airborne pollen results from both local and distant sources, although the pollen peaks usually appear when local sources are shedding the greatest amounts of pollen. Resuspension phenomena are probably more important than long-distance transport in explaining the presence of airborne pollen outside the flowering period. This information could be used to improve pollen forecasts.