Head Injuries Among Children Treated in US Emergency Departments, 2015-2019.

This study evaluates the epidemiology of nonfatal head injuries among children aged 1 to 4 years associated with consumer products and identifies the specific consumer products associated with these injuries. Data for children aged 1 to 4 years who presented to emergency departments (EDs) from 2015 to 2019 for a nonfatal head injury were extracted from the National Electronic Injury Surveillance System. An estimated 1 032 429 (95% confidence interval [CI]: 675 822-1 389 063) children presented to US EDs for head injuries, averaging 566 injuries daily. The average rate of head injury did not change over the 5-year study period (slope = -0.003; P = .852); it was highest among children aged 1 year (2.06 per 100 children aged 1 year), which was nearly 3 times that of children aged 4 years (rate ratio = 2.75; 95% CI: 2.73-2.77). Most injuries occurred at home (80.4%) and occurred from interacting with home furnishings (45.1%). This study underscores the need for increased head injury mitigation efforts among young children.

Skeletal muscle adiposity is a novel risk factor for poor cognition in African Caribbean women.

OBJECTIVE: Skeletal muscle adiposity (myosteatosis) is recognized as a major risk factor for cardiometabolic diseases, and it increases with aging. The relationship of myosteatosis with cognitive impairment is unknown. METHODS: The association of calf myosteatosis (measured by computed tomography-derived skeletal muscle density; higher values indicate less myosteatosis) with cognitive function was examined among 626 African Caribbean women who were aged 40 to 84 years, a population highly vulnerable to increased myosteatosis. Cognition was assessed by the Digit Symbol Substitution Test (DSST), a test of information processing speed (higher scores indicate better performance). Linear regression was used to assess the association of muscle density with DSST. RESULTS: Adjusting for age, education, muscle area, BMI, hypertension, diabetes, cardiovascular event history, lifestyle factors, lipid-lowering medication use, and menopausal status, a one-SD lower muscle density was associated with a 1.69-point lower DSST score (p = 0.002). BMI, diabetes, and hypertension interactions were not statistically significant, suggesting that the main association was not moderated by overall obesity or cardiometabolic diseases. CONCLUSIONS: These findings suggest that greater myosteatosis is associated with slower information processing speed, an early indicator of cognitive impairment. Further studies are needed to establish this association in this and other populations using an expanded battery of cognitive tests with longitudinal follow-up and to identify the biological mechanisms underlying this relationship.

The Puerto Rico Community Cancer Control Outreach Program: Developing Capacity-Building Activities on Cancer Screening Guidelines and HPV Vaccination Recommendations for Health Care Professionals.

OBJECTIVE: This study evaluated physicians' knowledge of cancer screening guidelines and human papillomavirus (HPV) recommendations. METHODS: The Puerto Rico Community Cancer Control Outreach Program in collaboration with the Comprehensive Cancer Control Program and the Breast and Cervical Cancer Early Detection Program developed an educational activity for physicians who attended a professional annual meeting. This activity consisted of 2 sessions: one about cancer screening guidelines and the other about HPV and HPV vaccination. A survey measuring the attendees' knowledge of the session topics was administered before and after each session. Changes in knowledge were assesed using McNemar's test with a significance level of 0.05. RESULTS: A total of 43 physicians responded to the survey about cancer screening, and 67 responded to the survey about HPV. A significant increase in the mean score of the pre-test (3.3 ± 1.42) and post-test (6.7 ± 1.38) of the cancer screening guidelines was observed as well as in that of the pre-test (7.82 ± 1.44) and post-test (9.66 ± 0.53) of HPV. The results showed that there were improvements regarding the most recent cervical cancer screening and colonoscopy guidelines as well as in the knowledge of HPV serotypes. CONCLUSION: This mid-day educational activity significantly improved knowledge among primary care physicians. Given its feasibility, future efforts should discuss the most recent cancer guidelines and emerging socio behavioral factors that impact vaccination.

Replacing sedentary time with light activity was associated with less adiposity across several depots in African ancestry men.

OBJECTIVE: The aim of this study was to determine whether displacement of sedentary time with activity was cross-sectionally associated with less adiposity among Black Caribbean men in the Tobago Health Study. METHODS: Objectively assessed activity was categorized as sedentary (< 1.5 metabolic equivalents; METs), light (≥ 1.5 to < 3.0 METs), or moderate-to-vigorous (≥ 3.0 METs) using the SenseWear Pro armband. Computed tomography scans of the chest, abdomen, liver, and thigh were used to assess subcutaneous and ectopic adipose tissue. The isotemporal substitution framework paired with linear regression was used to examine associations between activity and adiposity adjusting for age, height, total awake time, and multiple comparisons. RESULTS: On average, participants (n = 271) were 63 years old with 11.2 h/d of sedentary behavior, 4.5 h/d of light activity, and 54 min/d of moderate-to-vigorous activity. Replacing sedentary time with light activity was cross-sectionally associated with lower volume and higher density of abdominal and thigh subcutaneous adiposity, visceral adiposity, abdominal and thigh intermuscular adiposity, and pericardial adiposity and higher liver attenuation (p values ≤ 0.0001). CONCLUSIONS: Displacement of sedentary time with light activity was associated with less adiposity among this Black Caribbean cohort. Interventions focused on increasing light activity may be easier to maintain than higher intensity interventions and thus may be more successful at reducing adiposity.

¡Habla de VPH! An Educational Activity for College Students in Puerto Rico.

OBJECTIVE: To evaluate human papillomavirus (HPV) infection knowledge, willingness to get vaccinated, and vaccination uptake, following a brief educational activity entitled ¡Habla de VPH! (Let's talk about HPV!) in a sample of college students at the University of Puerto Rico, Bayamón. METHODS: Participants completed a self-administered questionnaire developed by the research team, which gathered information regarding sociodemographic characteristics, HPV vaccination status, and willingness to receive the vaccine. Once the participant completed the survey, the staff of the Outreach Program conducted an educational activity. Study participants completed a pre- and post-test, which included a scale with items related to knowledge about HPV infection, associated malignancies, and the vaccine. To compute the mean knowledge score for each test, the correct responses were summed; the total scores for each test ranged from 0 to 11. Follow-up interviews (3 and 6 months) explored knowledge changes and-in the previously unvaccinated students-vaccine uptake. RESULTS: A total of forty students answered the questionnaire. A significant difference between the average knowledge before (7.6 ± 2.1) and after the intervention (10.6 ±0.6) (P < .001) was observed. Of the non-vaccinated group, 59.3% reported being interested in receiving the vaccine. By the 3- and 6-month follow-ups, only 2 students had started the vaccine series. CONCLUSION: Knowledge about HPV and associated malignancies increased significantly. However, few students initiated the vaccine after either of the followups. Future efforts should line up the vaccine promotion and outreach activities with immunization services, making the vaccine available in the communities to be impacted.

Knowledge, Motivations and Concerns about Participation in Breast Cancer Clinical Trials in Puerto Rico.

BACKGROUND: Clinical trials (CT) in breast cancer have been crucial for new treatment discoveries. While participation in cancer CT is low, minorities are particularly underrepresented. This study aimed to identify factors influencing the participation in CTs based on the experiences of Latina breast cancer survivors in Puerto Rico (PR), especially their CT knowledge, motivations, and concerns. METHOD: Focus groups (FG) were conducted by two social workers and the University of Puerto Rico/MD Anderson Community Health Educator. Participants were stratified into two subgroups: a) women with CT experience and b) those without CT experience. Seven FG were completed among breast cancer survivors (n=34) at two hospitals located in Caguas and San Juan, PR. RESULTS: Our findings showed that participants expressed a basic knowledge and understanding of clinical trials. Motivations to participate included a desire to help others, non-monetary incentives to participation, self-benefits, readiness to participate based on the phases of illness, and enhanced relationships with the clinical trial recruitment team. Regardless of their previous experience with CTs, participants expressed concerns about participation including limited of knowledge about trial procedures and results, and lack of transportation, childcare, and support from family. RECOMMENDATIONS: The barriers and motivations identified for CT participation are modifiable and best targeted using a multidisciplinary approach. Social workers could play a potential role in participant recruitment and retention by clarifying research protocols to potential participants, as well as conducting CT. Our findings can help enhance capacity and training efforts for health professionals involved in CT recruitment and retention in culturally-relevant ways.

Risk of Anal Cancer in Women With a Human Papillomavirus-Related Gynecological Neoplasm: Puerto Rico 1987-2013.

OBJECTIVE: The aim of the study was to estimate the magnitude of the association between HPV-related gynecological neoplasms and secondary anal cancer among women in Puerto Rico (PR). MATERIALS AND METHODS: We identified 9,489 women who had been diagnosed with a primary cervical, vaginal, or vulvar tumor during 1987-2013. To describe the trends of invasive cervical, vulvar, vaginal, and anal cancer, the age-adjusted incidence rates were estimated using the direct method (2000 US as Standard Population). Standardized incidence ratios (observed/expected) were computed using the indirect method; expected cases were calculated using 2 methods based on age-specific rates of anal cancer in PR. The ratio of standardized incidence ratios of anal cancer was estimated using the Poisson regression model to estimate the magnitude of the association between HPV-gynecologic neoplasms and secondary anal cancer. RESULTS: A significant increase in the incidence trend for anal cancer was observed from 1987 to 2013 (annual percent change = 1.1, p < .05), whereas from 2004 to 2013, an increase was observed for cervical cancer incidence (annual percent change = 3.3, p < .05). The risk of secondary anal cancer among women with HPV-related gynecological cancers was approximately 3 times this risk among women with non-HPV-related gynecological cancers (relative risk = 3.27, 95% CI = 1.37 to 7.79). CONCLUSIONS: Anal cancer is increasing among women in PR. Women with gynecological HPV-related tumors are at higher risk of secondary anal cancer as compared with women from the general population and with those with non-HPV-related gynecological cancers. Appropriate anal cancer screening guidelines for high-risk populations are needed, including women with HPV-related gynecological malignancies and potentially other cancer survivors.