Community health worker outreach to farmworkers in rural North Carolina: Learning from adaptations to the SARS-CoV-2 pandemic.

BACKGROUND: Community health workers represent a critical part of the health outreach and services for migrant and seasonal farmworkers ('farmworkers') in rural areas of the United States. PURPOSE: We sought to identify adaptations to farmworker patient engagement and health outreach made by community health workers during the first 18 months of the COVID-19 pandemic. METHODS: In this qualitative study, we used semi-structured interviews with community health workers from August 2020 to February 2022 (n = 21). Two coders used thematic analysis to identify three themes related to the experiences of community health workers in conducting health education and outreach to farmworkers prior to and following the onset of the pandemic. FINDINGS: We found themes related to pre-pandemic outreach efforts to provide health education resource sharing with farmworkers and pandemic-related outreach efforts that included adoption of porch drops and distanced delivery of health education, adaptation of modes of health education and communication through technology and the internet, and taking on new roles related to COVID-19. Finally, we identified changes that reverted after the pandemic or will continue as adaptations. CONCLUSIONS: Community health workers created practice-based innovations in outreach in response to the COVID-19 pandemic. These innovations included new COVID-19 related roles and new modes of health education and outreach, including the use of digital resources. The changes developed for emergency use in COVID-19, particularly related to internet and technology, have likely altered how community health workers conduct outreach in North Carolina going forward. Funders, community health worker training programs, and researchers should take note of these innovations. PATIENT OR PUBLIC CONTRIBUTION: Community health workers who typically come from patient populations and provide critical navigation and connection with the health care system advised on the design and creation of this research project, including serving on an advisory board. Two authors have experience working as community health workers.

Point-of-Care Ultrasound of a Nasal Septal Abscess.

ABSTRACT: Although nasal septal abscesses (NSA) are rare, complications can be significant and devastating. Thus, timely diagnosis of NSA is critical. In this case report, we describe the use of point-of-care ultrasound in diagnosing NSA in a healthy boy presenting with viral upper respiratory infection symptoms and fever. Point-of-care ultrasound findings resulted in expediting this patient's treatment and transfer to a quaternary care center for definitive treatment.

Ovarian serous borderline tumor with mural nodules of anaplastic carcinoma and omental involvement: A case report.

Mural nodules are rarely identified in cystic ovarian neoplasms, and have been categorized into sarcoma-like, sarcomatous, and anaplastic carcinomatous types. Most reports of these mural nodules have been described in mucinous ovarian tumors. In this case report, we describe an ovarian serous borderline tumor with mural nodules composed of high-grade carcinoma with anaplastic features and necrosis, including the morphologic features, immunoprofile, and results of tumor DNA sequencing. Omental involvement was also identified. Recognition of this phenomenon in serous tumors is important, so that thickened areas of cyst wall in ovarian serous tumors will be thoroughly examined.

Practical Advice Regarding the Reliability of the Patient Educational Materials Assessment Tool for Health Educators.

The quality of patient education materials is an important issue for health educators, clinicians, and community health workers. We describe a challenge achieving reliable scores between coders when using the Patient Educational Materials Assessment Tool (PEMAT) to evaluate farmworker health materials in spring 2020. Four coders were unable to achieve reliability after three attempts at coding calibration. Further investigation identified improvements to the PEMAT codebook and evidence of the difficulty of achieving traditional interrater reliability in the form of Krippendorff's alpha. Our solution was to use multiple raters and average ratings to achieve an acceptable score with an intraclass correlation coefficient. Practitioners using the PEMAT to evaluate materials should consider averaging the scores of multiple raters as PEMAT results otherwise may be highly sensitive to who is doing the rating. Not doing so may inadvertently result in the use of suboptimal patient education materials.

Social inequalities in health: duration of unemployment unevenly effects on the health of men and women.

BACKGROUND: Employment status is an important determinant of health inequalities. The aim of this article is to analyze the association between duration of unemployment and the presence of cardiovascular risk factors, self-perception of health and presence of depression and anxiety, assessing differences in the effects of unemployment by sex and age. METHODS: The sample was composed of 12 123 people (52.4% men), 18 to 74 years old (mean age= 43.5 years, SD = 10.4). Logistic regression analyses were used to study the influence of duration of unemployment on health ('0 days', '≤11 months' and '≥12 months'). Sex, age, level of education, employment status and time spent unemployed, as well as tobacco and alcohol use and physical activity, were considered. Morbidity variables were hypertension, hypercholesterolemia, diabetes, obesity, depression and anxiety, and a subjective health assessment. RESULTS: The results showed both unemployed men and women had worse outcome in health compared with their active counterparts. The risk of hypertension was presented in long-term unemployed men, which had 1.3 times more likely to suffer from hypertension. The risk of obesity was presented only in unemployed women, which had 1.5 times more risk of obesity, doubling the risk (OR= 2.2) among women under age 40. The unemployment had a protective effect against anxiety among younger women (OR = 0.53). CONCLUSION: It has been observed a different influence of unemployment time on men and women's health. The employment status should be considered in public health policy agendas with the purpose of reducing inequalities in health.

Health systems around the world - a comparison of existing health system rankings.

BACKGROUND: Existing health systems all over the world are different due to the different combinations of components that can be considered for their establishment. The ranking of health systems has been a focal points for many years especially the issue of performance. In 2000 the World Health Organization (WHO) performed a ranking to compare the Performance of the health system of the member countries. Since then other health system rankings have been performed and it became an issue of public discussion. A point of contention regarding these rankings is the methodology employed by each of them, since no gold standard exists. Therefore, this review focuses on evaluating the methodologies of each existing health system performance ranking to assess their reproducibility and transparency. METHODS: A search was conducted to identify existing health system rankings, and a questionnaire was developed for the comparison of the methodologies based on the following indicators: (1) General information, (2) Statistical methods, (3) Data (4) Indicators. Overall nine rankings were identified whereas six of them focused rather on the measurement of population health without any financial component and were therefore excluded. Finally, three health system rankings were selected for this review: "Health Systems: Improving Performance" by the WHO, "Mirror, Mirror on the wall: How the Performance of the US Health Care System Compares Internationally" by the Commonwealth Fund and "the Most efficient Health Care" by Bloomberg. RESULTS: After the completion of the comparison of the rankings by giving them scores according to the indicators, the ranking performed the WHO was considered the most complete regarding the ability of reproducibility and transparency of the methodology. CONCLUSIONS: This review and comparison could help in establishing consensus in the field of health system research. This may also help giving recommendations for future health rankings and evaluating the current gap in the literature.

¿Disminuye el exceso ponderal en la población adulta? Contraste entre las Encuestas Europeas de Salud en España de 2009 y 2014 / Is overweight on the decrease in the adult population? differences between the 2009 and 2014 European Health Surveys in Spain

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Physically Active Men Show Better Semen Parameters than Their Sedentary Counterparts.

BACKGROUND: The quality of semen depends upon several factors such as environment, life style, physical activity, age, and occupation. The aim of this study was to analyze and compare the conventional and functional semen parameters in men practicing vigorous physical activity to those of sedentary men. MATERIALS AND METHODS: In this descriptive cross-sectional study, semen samples of 17 physically active men and 15 sedentary men were collected for analysis. Semen analysis was performed according to the World Health Organization (WHO) guidelines, while functional parameters were evaluated by flow cytometry. RESULTS: Results showed that several semen parameters (semen volume, viability, progressive motility, total motility, normal morphology, and moribund cells) were superior in the physically active group in comparison with the sedentary group. Semen parameters such as viability, progressive motility and total motility, as well as the percentage of moribund spermatozoa were significantly different between both groups. However, sperm DNA damage, lipid peroxidation and mitochondrial potential were not significantly different among the groups. CONCLUSION: Nevertheless, the physical activity shows better semen parameters than sedentary group. Taken together, our results demonstrate that regular physical activity has beneficial impact in sperm fertility parameters and such a life style can enhance the fertility status of men.

Influence of malnutrition upon all-cause mortality among children in Swaziland.

OBJECTIVE: To analyze the effect of the type of malnutrition, sex, age and the presence of edema upon all-cause mortality in children under 5 years of age. MATERIAL AND METHODS: A cross-sectional study was conducted during 2010 and 2011 in Swaziland. Sex, age, weight and height were taken to classify nutritional status according to the 2006 WHO growth standards: stunting (low height for age), wasting (low weight for height or low body mass index for age) and underweight (low weight for age). The sample (309 boys and 244 girls under 5 years of age) was analyzed by sex and age groups (under and equal/over 12 months). The association between variables was evaluated using the χ2 test. Cox regression analysis (HR, 95% CI) was used to assess the likelihood of mortality. RESULTS: The mortality risk in malnourished children under one year of age was lower among females and increased in the presence of severe edema. Wasting combined with underweight increased the mortality risk in children under 12 months of age 5-fold, versus 11-fold in older children. The combination of stunting, wasting and underweight was closely associated to mortality. Stunting alone (not combined with wasting) did not significantly increase the mortality risk. CONCLUSIONS: Sex, severe edema and wasting are predictors of mortality in malnourished children. Regardless of these factors, children with deficiencies referred to weight for height and weight for age present a greater mortality risk in comparison with children who present stunting only.

Influence of malnutrition upon all-cause mortality among children in Swaziland / Influencia de la malnutrición en la mortalidad por todas las causas en menores de Suazilandia

Objective: To analyze the effect of the type of malnutrition, sex, age and the presence of edema upon all-cause mortality in children under 5 years of age. Material and methods: A cross-sectional study was conducted during 2010 and 2011 in Swaziland. Sex, age, weight and height were taken to classify nutritional status according to the 2006 WHO growth standards: stunting (low height for age), wasting (low weight for height or low body mass index for age) and underweight (low weight for age). The sample (309 boys and 244 girls under 5 years of age) was analyzed by sex and age groups (under and equal/over 12 months). The association between variables was evaluated using the χ2 test. Cox regression analysis (HR, 95% CI) was used to assess the likelihood of mortality. Results: The mortality risk in malnourished children under one year of age was lower among females and increased in the presence of severe edema. Wasting combined with underweight increased the mortality risk in children under 12 months of age 5-fold, versus 11-fold in older children. The combination of stunting, wasting and underweight was closely associated to mortality. Stunting alone (not combined with wasting) did not significantly increase the mortality risk. Conclusions: Sex, severe edema and wasting are predictors of mortality in malnourished children. Regardless of these factors, children with deficiencies referred to weight for height and weight for age present a greater mortality risk in comparison with children who present stunting only (AU)

Objetivo: Analizar el efecto del tipo de malnutrición, de la edad, el sexo y la presencia de edema sobre la mortalidad en menores de cinco años. Material y métodos: Estudio transversal llevado a cabo durante 2010 y 2011 en Suazilandia. Se tomaron el sexo, la edad en meses, la talla y el peso y se clasificó el estado nutricional de los menores considerando: desnutrición crónica (stunting o baja talla para la edad), aguda (wasting o bajo peso para la talla o bajo índice de masa corporal para la edad) y bajo peso para la edad (underweight) de acuerdo a los estándares de crecimiento de la OMS del 2006. La muestra (309 niños, 244 niñas, menores de 5 años) se analizó por sexo y edad considerando separadamente los menores y mayores de 12 meses. La asociación entre variables se evaluó utilizando el test de χ2 y la regresión de Cox (HR 95% CI) fue utilizada para determinar la probabilidad de muerte. Resultados: El riesgo de muerte en los menores malnutridos menores de un año es menor en las niñas y aumenta significativamente con la presencia de edema severo. La desnutrición aguda combinada con el bajo peso multiplica por cinco el riesgo de mortalidad en los menores de 12 meses y por once en los mayores de un año. La combinación de desnutrición crónica, aguda y bajo peso está estrechamente asociada a la mortalidad. La malnutrición crónica por sí sola no incrementa significativamente el riesgo de muerte. Conclusiones: El sexo, la severidad del edema y la desnutrición aguda son predictores de mortalidad. Con independencia de estos factores, los menores con déficit de peso para la talla o de peso para la edad presentan mayor riesgo de mortalidad que los menores que padecen únicamente desnutrición crónica (AU)

Epidemiology of Suicide in Cuba, 1987-2014.

INTRODUCTION Suicide is a health problem influenced by biological, genetic, psychological, social and economic factors. It is responsible for 50% of violent deaths in the male population, worldwide, and 71% in the female. In the Americas, 65,000 deaths by suicide occur every year. It is the ninth most frequent cause of death in Cuba, and third among people aged 10-19. OBJECTIVE Characterize the epidemiology of suicide in Cuba from 1987 to 2014. METHODS A retrospective descriptive study was conducted. The information comprised all records of death by suicide from January 1, 1987 to December 31, 2014, in the Cuban Ministry of Public Health's National Statistics Division database. The variables were sex, age, skin color, employment status/occupation, marital status, and method of suicide. Crude and age-standardized mortality rates and age-sex specific mortality rates were calculated, all per 100,000 population, as well as the sex ratio. Relative change over the series was calculated as a percentage. Distribution of suicides by variable was calculated and proportions expressed as percentages. RESULTS A total of 51,113 deaths by suicide were reported (annual average 1825), of which 34,671 (67.8%) were among men. The sex ratio was 2.1:1 for the entire study period, and 3.9:1 for 2011-2014. Over the course of the period studied, age-standardized suicide rates decreased from 23.9 to 10.8 per 100,000 population (54.8% reduction). The group aged ≥60 years had the highest average age-standardized rate, 44.6 per 100,000 population. The highest suicide burden by age was in the group aged 20-59 years (60.5%). By skin color, the highest burden was in those recorded as white, 68.9%. By marital status, the highest burden was in persons with a stable partner (46.7%), and by employment status/occupation, in retired (25.9%). The most commonly used method was hanging (59.4%). CONCLUSIONS Over the course of about three decades, suicide mortality rates have declined by almost half and they are still slightly higher than overall rates in the Americas. The most commonly used method is hanging. The sex ratio is greater than two and has increased over time. The highest rates occur in the group aged ≥60 years, but finer stratification is needed to identify an age-related risk trend. In view of Cuba's aging population, these results are of interest for epidemiology and public health. KEYWORDS Suicide, suicide attempt, death, mental health, Cuba.

Pyruvate kinase isoform expression alters nucleotide synthesis to impact cell proliferation.

Metabolic regulation influences cell proliferation. The influence of pyruvate kinase isoforms on tumor cells has been extensively studied, but whether PKM2 is required for normal cell proliferation is unknown. We examine how PKM2 deletion affects proliferation and metabolism in nontransformed, nonimmortalized PKM2-expressing primary cells. We find that deletion of PKM2 in primary cells results in PKM1 expression and proliferation arrest. PKM1 expression, rather than PKM2 loss, is responsible for this effect, and proliferation arrest cannot be explained by cell differentiation, senescence, death, changes in gene expression, or prevention of cell growth. Instead, PKM1 expression impairs nucleotide production and the ability to synthesize DNA and progress through the cell cycle. Nucleotide biosynthesis is limiting, as proliferation arrest is characterized by severe thymidine depletion, and supplying exogenous thymine rescues both nucleotide levels and cell proliferation. Thus, PKM1 expression promotes a metabolic state that is unable to support DNA synthesis.

Indicadores de riesgo cardiovascular, patrones de lactancia y estilo de vida de la madre durante el proceso de crecimiento y desarrollo fetal e infantil / Indicators of cardiovascular risk, breastfeeding patterns and mother’s lifestyle during fetal growth and child development

Introducción: La nutrición en las primeras etapas del ciclo vital humano podría ejercer un efecto programador en la fisiología y el metabolismo del individuo condicionando su estado de salud en el futuro. Objetivo: Describir los patrones de lactancia y el estado nutricional actual de una muestra de 217 niños/as analizando la posible relación entre las condiciones nutricionales en las que transcurre el proceso de crecimiento y desarrollo y el riesgo de padecer enfermedades cardiovasculares en el futuro. Métodos: Mediante antropometría se tomó peso, talla, perímetro de la cintura, se calculó el Índice de Masa Corporal (IMC) y se midió la presión arterial sistólica y diastólica como indicador temprano de riesgo cardiovascular. Resultados: El 94,7% de las madres confían en la leche materna como el mejor alimento para el recién nacido pero solo el 88,8% inician la lactancia materna en los primeros días después del parto y solo un 15,6% alcanzan los 6 meses de lactancia materna exclusiva recomendada por la Organización Mundial de la Salud. El 29,3% de los niños y el 24% de las niñas presentaron sobrepeso y, obesidad, el 10,3% y 6% respectivamente. Existe variación lineal significativa e inversa entre la duración de la lactancia materna exclusiva y el perímetro de cintura (p=0,033; B= -0,215), también con la tensión arterial diastólica (p=0,032; B = -0,215). Se encuentra una tendencia a aumentar el IMC cuando la duración de la lactancia materna exclusiva disminuye. Conclusión: Los patrones de lactancia descritos en la muestra no se adecuan a las recomendaciones internacionales y resulta evidente la relación entre variables fisiológicas indicadores tempranos de riesgo cardiovascular e indicadores de acúmulo graso (AU)

ABTRACT Introduction: Nutrition in the early stages of the human life cycle could have a programmer effect on physiology and metabolism of the individual conditioning their health in the future. Objective: To describe patterns of breastfeeding and the current nutritional status of a sample of 217 children analyzing the possible relationship between nutritional conditions that elapses growth and development process and the risk of cardiovascular disease in the future. Methods: Weight, height and waist circumference was taken by anthropometry, Body Mass Index (BMI) was calculated and systolic and diastolic blood pressure as an early indicator of cardiovascular risk was measured. Results: 94.7% of mothers rely on breast milk as the best food for newborns but only 88.8% initiated breastfeeding in the first few days after birth and only the 15.6% of them reach 6 months of exclusive breastfeeding recommended by the World Health Organiza - tion. The 29.3% of boys and 24% of girls were overweight and there were obesity in 10.3% and 6% respectively. There is significant inverse linear variation between the duration of exclusive breastfeeding and waist circumference (p = 0.033, B = -0.215), also with diastolic blood pressure (p = 0.032, B = -0.215). There is a trend to increase the BMI when the duration of exclusive breastfeeding decreases. Conclusion: The breastfeeding patterns described in the sample do not conform to international recommendations and is obvious the relationship between phy - siological variables indicative of early cardiovascular risk and fat accumulation (AU)

Body mass index through self-reported data and body image perception in Spanish adults attending dietary consultation.

OBJECTIVES: The aim of this study was to explore, based on sex and age, knowledge regarding weight, height, and the perception of body shape in Spanish adults who attend dietary consultation. We also wanted to determine the participants' desired body shapes and what they considered their best health status. METHODS: The sample consisted of 8100 women and 1220 men from Spain. They were between the ages of 18 and 75 y. Weight (kg) and height (cm) were measured and body mass index (BMI) was calculated. Participants were nutritionally classified following the cutoffs proposed by the World Health Organization. Each individual was asked about his or her weight and height and self-reported BMI was calculated. They also answered a test of body image perception through drawings of human silhouettes that corresponded to an exact BMI. With this, perceived BMI, desired BMI, and BMI considered healthy were estimated. Parametric statistic tests for contrast of mean and percentages were applied. RESULTS: Self-reported and perceived BMI underestimate the BMI obtained through anthropometry. Differences between measured and self-reported BMI are lower in women and increase with age in both sexes. The same result was obtained when comparing measured BMI with perceived BMI through silhouette test. On average, desired BMI and healthy BMI were in the limits of normal weight for all ages and both sexes. However, the difference between them was also lower in women. CONCLUSION: Age and sex influence the perception of excess weight and body image. This could condition the demand of dietary treatment to improve the nutritional status.

Infertilidad masculina y su relación con algunas condiciones médicas / Male infertility and the relationship with some medical conditions

La infertilidad generalmente se relaciona con la capacidad fértil de la mujer, sin embargo, también es causada por alteraciones del componente masculino asociadas a factores de riesgo como el aumento de la edad, consumo de cigarrillo o marihuana y el sedentarismo. En esta revisión se discute la relación que guardan algunas condiciones médicas como la diabetes, las enfermedades tiroideas, la obesidad y las infecciones virales con la reducción de la fertilidad masculina.

Usually infertility is related to the reproductive capacity of women, but also it is related to alterations of the male part that involves risk factors such as aging, cigarette and marijuana smoking, and sedentary lifestyle. This review shows the relationship between some health disorders such as diabetes,thyroid disease, obesity, and viral infections with reduced male fertility.

Relación entre la actividad física, el sedentarismo y la calidad seminal / Relationship between physical activity, sedentary lifestyle and semen quality

La preocupación por el declive de los parámetros seminales humanos se ha incrementado en los últimos años, en especial por el aumento en las consultas por infertilidad. La calidad seminal puede verse influenciada por factores ambientales o propios del estilo de vida y dentro de los últimos se encuentra la práctica de actividad física. Los resultados de los estudios que han evaluado los efectos del estilo de vida físicamente activo sobre la calidad seminal han sido contradictorios, por lo que la relación entre ambos no está claramente establecida; no obstante, se ha propuesto que la práctica de actividad física podría tener efectos positivos sobre la calidad seminal, así como tiene diferentes beneficios para la salud. La posibilidad de incluir la mejoría en la calidad seminal dentro de las razones para incentivar el estilo de vida físicamente activo en las personas, necesita del aumento en el conocimiento acerca de la influencia que tienen diversos aspectos involucrados en la práctica de actividad física, sobre los parámetros espermáticos. El objetivo de esta revisión de la literatura es recopilar los principales aspectos relacionados con el efecto del estilo de vida, en especial de la actividad física y el sedentarismo, sobre la calidad seminal.

Concern about the decline in human semen parameters has grown in recent years, due in part to the increase in infertility consultations. Semen quality may be influenced by environmental or lifestyle factors such as the practice of physical activity but the relation between semen quality and physically active lifestyle is not clearly established. Nevertheless, it has been proposed that physical activity might have positive effects on semen quality as well as it has various health benefits. To possibly include the improvement of semen quality on the reasons to stimulate the physically active lifestyle in people, it's necessary to increase the knowledge about the influence of diverse aspects involved on the practice of physical activity on the sperm parameters. The purpose of this literature review is to compile the main aspects related to the effect of lifestyle, particularly physical activity and sedentarism on semen quality.

Vías de demanda para la atención en salud mental / Demand pathways for mental health assistance

Gaceta Médica Espirituana Univ. Ciencias Médicas. Sancti Spíritus Vol.1, No. 2 (1999) ISSN 1608 - 8921 Trabajo Original Vías de demanda para la atención en salud mental. Demand pathways for mental health assistance. Lic. Milvia Socorro Rojas Rodríguez1, Dr.C. Guillermo Barrientos de Llaño2, Dra. Paula Lomba Acevedo3, Lic. Teresa Hernández González4 1. Máster en Psiquiatría Comunitaria. Licenciada en Enfermería. Profesor Instructor en Psiquiatría y Neurocirugía. Hospital Clínico Quirúrgico Docente Provincial Camilo Cienfuegos. Sancti Spíritus. 2. Doctor en Ciencia. Profesor Titolar. Facoltad 10 de octubre. 3. Master Psiquiatría Comunitaria. Profesor Asistente en Psiquiatría. Facultad 10 de octubre. 4. Licenciada en defectología. Hospital Clínico Quirúrgico Docente 10 de Octubre. RESUMEN Se realiza un trabajo sobre la vía de demanda de atención de salud mental. Se estudian 76 casos que demandaron atención en las áreas de salud de Lawton, Luyanó. Santo Suárez y el cuerpo de guardia de la unidad de intervención en crisis del servicio de Psiquiatría del Hospital Docente Clínico Quirúrgico "10 de Octubre". La mayor parte de los casos fueron vistos en el cuerpo de guardia y en el área de Lawton. Los casos estuvieron con preferencia entre los 20 y 59 años de edad con un 72,3 % del sexo femenino, siendo 40 de ellos casados. De los 76 caos estudiados 73 tenían una posición social promedio y menor del promedio y menor del promedio. Los casos llegaron a través del médico de la familia y el médico general en su gran mayoría. También hubo muchos casos que demandaron asistencia directamente en la atención especializada. La mayor parte de los casos fueron atendidos -antes de la semana de iniciado el episodio actual. El tratamiento que con más frecuencia se oferto fue medicamentoso. Los problemas principales presentados fueron los relativos a la ansiedad y la de presión, así como el intento suicida. Se evidencia la necesidad de realizar estudios más profundos de esta temática donde se destaque la importancia de la vinculación del médico y la enfermera de la familia con el equipo de salud mental.