Caregiver Experience with Bicultural, Bilingual Family Navigators to Support Early Childhood Development.

Recognizing the inequities in developmental screening and services for children in immigrant families, a pediatric primary care clinic in partnership with a community-based early childhood program co-created a bicultural, bilingual early childhood developmental (ECD) family navigator program in Seattle, Washington. The primary aim of this study is to explore caregivers' perspectives about this program. Twenty-seven caregivers of young children participated in semi-structured interviews that were thematically analyzed. Three key themes were identified: 1) sharing language and culture, 2) facilitating accessibility, and 3) promoting development. Caregivers valued linguistic and cultural concordance between the navigator and the family, the navigator's approach to screening to improve accessibility and reduce barriers, and the focus on supporting early childhood development. Understanding caregivers' experience with the ECD family navigator development program and the aspects they value, informs clinic-based approaches to ensure families of diverse language and cultural backgrounds have accessible development screening and connection to services.

Perspectives of public health organizations partnering with refugee, immigrant, and migrant communities for comprehensive COVID-19 case investigation and contact tracing.

Objectives: To understand public health organizations' experiences providing comprehensive COVID-19 case investigation and contact tracing, and related promising practices with refugee, immigrant and migrant communities. Methods: We interviewed public health professionals (September 2020 to February 2021) from local and state health departments using a geographically stratified, purposive sampling approach. A multidisciplinary team at the National Resource Center for Refugees, Immigrants and Migrants (NRC-RIM) conducted a thematic analysis of the data. Results: Six themes were identified: understanding community and public health context, cultivating relationships, ensuring linguistic and cultural concordance, communicating intentionally, evolving response, and implementing equity. The interconnection of themes and promising practices is explored. Conclusion: As public health continues to learn from and build upon COVID-19 response experiences, the thematic findings and potential promising practices identified in this project may foster proactive, community-engaged solutions for public health, and other organizations working and partnering with refugee, immigrant, and migrant communities. Implementing these findings with COVID-19 into current and future public health crisis responses may improve public health, collaborations with refugee, immigrant, and migrant communities, and staff wellbeing.

Experiences of American Health Departments, Health Systems, and Community Organizations in COVID-19 Vaccine Provision for Refugee, Immigrant, and Migrant Communities.

Effective provision of COVID-19 vaccines could mitigate the disproportionate impact of the COVID-19 pandemic experienced by many immigrant communities. To describe organizational experiences in using COVID-19 vaccination programs, qualitative interviews were conducted from September 2020 to April 2021 with representatives from public health, health system, and community organizations responding to the COVID-19 pandemic among immigrant communities across the United States. Interviews followed a semistructured interview guide and were audio recorded, transcribed, and coded. A latent thematic analysis was facilitated by Dedoose software. Interviews representative of 18 public health departments, 20 healthcare systems, and 18 community organizations were included in the analysis. Five identified themes referenced the importance of 1) appreciating community and individual heterogeneity in health priorities and attitudes; 2) addressing vaccine fears with trustworthy messages; 3) ensuring equitable access to vaccine opportunities; 4) making substantive investments in community partnerships and outreach; and 5) adapting to meet new needs. It is essential that vaccine efforts consider community heterogeneity, communicate in a trustworthy and culturally and linguistically appropriate manner, strive for equitable provision of care, build partnerships, and learn from prior experiences.

Spanish Translation of a Parent-Reported Hospital-to-Home Transition Experience Measure.

OBJECTIVES: A critical focus of pediatric hospital systems is to improve the quality of hospital-to-home transitions. Although validated patient-reported measures evaluating these improvement efforts exist for English-speaking families, a comprehensive measure to assess transition quality among families who speak a language other than English does not yet exist. METHODS: We used a team consensus translation approach to translate and culturally adapt the previously validated Pediatric Transition Experience Measure (P-TEM), a caregiver-reported hospital-to-home transition quality measure, from English to Spanish. We describe our rigorous translation approach, which involved a series of steps to preserve the original meaning of the P-TEM through careful team-based linguistic and cultural adaptation of the measure into Spanish. During this process, we also found additional opportunities to improve the understandability and content validity of the original English version of P-TEM. We then pilot tested the new Spanish P-TEM with 36 parents and administered the revised English P-TEM with 125 caregivers (ie, parents/legal guardians). RESULTS: In pilot testing, none of the Spanish-speaking parents reported difficulty understanding questions, though 6% (2/36) expressed difficulty with understanding the response scale, prompting a change to present clearer scale anchors. Mean scores on the Spanish P-TEM were 95.4 (SD, 9.6) for the total score. Mean scores on the revised English P-TEM were 88.6 (SD, 15.6; total). CONCLUSIONS: Using a team consensus translation approach is a comprehensive and collaborative approach that allows for translation of measures originally developed for English-speaking families to be translated in a way that is reliable, accurate, and culturally appropriate.

"Beyond just the four walls of the clinic": The roles of health systems caring for refugee, immigrant and migrant communities in the United States.

This article is part of the Research Topic 'Health Systems Recovery in the Context of COVID-19 and Protracted Conflict'. Introduction: Refugee, immigrant and migrant (hereafter referred to as "immigrant") communities have been inequitably affected by the COVID-19 pandemic. There is little data to help us understand the perspectives of health systems on their role, in collaboration with public health and community-based organizations, in addressing inequities for immigrant populations. This study will address that knowledge gap. Methods: This qualitative study used semi-structured video interviews of 20 leaders and providers from health systems who cared for immigrant communities during the pandemic. Interviewees were from across the US with interviews conducted between November 2020-March 2021. Data was analyzed using thematic analysis methods. Results: Twenty individuals representing health systems participated with 14 (70%) community health centers, three (15%) county hospitals and three (15%) academic systems represented. The majority [16 health systems (80%)] cared specifically for immigrant communities while 14 (70%) partnered with refugee communities, and two (10%) partnered with migrant farm workers. We identified six themes (with subthemes) that represent roles health systems performed with clinical and public health implications. Two foundational themes were the roles health systems had building and maintaining trust and establishing intentionality in working with communities. On the patient-facing side, health systems played a role in developing communication strategies and reducing barriers to care and support. On the organizational side, health systems collaborated with public health and community-based organizations, in optimizing pre-existing systems and adapting roles to evolving needs throughout the pandemic. Conclusion: Health systems should focus on building trusting relationships, acting intentionally, and partnering with community-based organizations and public health to handle COVID-19 and future pandemics in effective and impactful ways that center disparately affected communities. These findings have implications to mitigate disparities in current and future infectious disease outbreaks for immigrant communities who remain an essential and growing population in the US.

"How can you advocate for something that is nonexistent?" (CM16-17) Power of community in a pandemic and the evolution of community-led response within a COVID-19 CICT and testing context.

Formal and informal bilingual/bicultural organizations and networks form the backbone of support for refugee, immigrant, and migrant (RIM) communities in the United States. They are pivotal in mitigating barriers and inequities in social and structural determinants of health. These organizations and networks are situated within the communities they serve, and often are established and run by members of a community, to serve the community. In the United States, the COVID-19 pandemic surfaced and widened existing health inequities for some racial and ethnic communities. Our primary objectives were to: (1) describe the processes that underpinned the pivotal role of immigrant-serving community structures in developing and implementing culturally sustaining programming in the context of pandemic response, and (2) amplify the voices of community experts, as they shared experiences and perspectives around these humanistic and community-centered approaches. We applied a community case study approach to a national sample of RIM-serving community structures representing broad country/region-of-origin, cultural, and linguistic identities. Community engagement strategies utilized in the project period included engaging community partners to identify and facilitate connections, and consult on analysis and dissemination. The project team conducted 20 in-depth, semi-structured interviews with a purposive sample of community experts/community organizations. Sampling strategy was further informed by immigrant identity (i.e., characterization of status) and geography (i.e., United States Department of Health & Human Services, Office of Intergovernmental and External Affairs Regions). Through thematic analysis, results identified key contextual, process-, and impact-oriented themes inherent to community-led COVID-19 responses, that were situated within and around the public and health system response to the pandemic. As public health and health systems scrambled to address acute and unprecedented barriers to access, distribution of COVID-19-related health resources and services, and disparate health outcomes, community structures diligently and intentionally reimagined and reconceptualized their response to COVID-19, frequently in the setting of scarce resources. The grassroots response evolved as a counter-narrative to top-down equity processes, historically defined by systems and applied to the community.

Profile of Myracrodruon urundeuva Volatile Compounds Ease of Extraction and Biodegradability and In Silico Evaluation of Their Interactions with COX-1 and iNOS.

Myracrodruon urundeuva Fr. Allem. (Anacardiaceae) is a tree popularly known as the "aroeira-do-sertão", native to the caatinga and cerrado biomes, with a natural dispersion ranging from the Northeast, Midwest, to Southeast Brazil. Its wood is highly valued and overexploited, due to its characteristics such as durability and resistance to decaying. The diversity of chemical constituents in aroeira seed has shown biological properties against microorganisms and helminths. As such, this work aimed to identify the profile of volatile compounds present in aroeira seeds. Headspace solid phase microextraction was employed (HS-SPME) using semi-polar polydimethylsiloxane-divinylbenzene fiber (PDMS/DVB) for the extraction of VOCs. 22 volatile organic compounds were identified: nine monoterpenes and eight sesquiterpenes, in addition to six compounds belonging to different chemical classes such as fatty acids, terpenoids, salicylates and others. Those that stood out were p-mentha-1,4, 4(8)-diene, 3-carene (found in all samples), caryophyllene and cis-geranylacetone. A virtual docking analysis suggested that around 65% of the VOCs molar content from the aroeiras seeds present moderate a strong ability to bind to cyclooxygenase I (COX-I) active site, oxide nitric synthase (iNOS) active site (iNOSas) or to iNOS cofactor site (iNOScs), corroborating an anti-inflamatory potential. A pharmacophoric descriptor analysis allowed to infer the more determinant characteristics of these compounds' conferring affinity to each site. Taken together, our results illustrate the high applicability for the integrated use of SPME, in silico virtual screening and chemoinformatics tools at the profiling of the biotechnological and pharmaceutical potential of natural sources.

Optimization of Extraction Conditions and Characterization of Volatile Organic Compounds of Eugenia klotzschiana O. Berg Fruit Pulp.

Eugenia klotzschiana O. Berg is a native species to the Cerrado biome with significant nutritional value. However, its volatile organic compounds (VOCs) chemical profile is not reported in the scientific literature. VOCs are low molecular weight chemical compounds capable of conferring aroma to fruit, constituting quality markers, and participating in the maintenance and preservation of fruit species. This work studied and determined the best conditions for extraction and analysis of VOCs from the pulp of Eugenia klotzschiana O. Berg fruit and identified and characterized its aroma. Headspace solid-phase microextraction (HS-SPME) was employed using different fiber sorbents: DVB/CAR/PDMS, PDMS/DVB, and PA. Gas chromatography and mass spectrometry (GC-MS) were employed to separate, detect, and identify VOCs. Variables of time and temperature of extraction and sample weight distinctly influenced the extraction of volatiles for each fiber. PDMS/DVB was the most efficient, followed by PA and CAR/PDMS/DVB. Thirty-eight compounds that comprise the aroma were identified among sesquiterpenes (56.4%) and monoterpenes (30.8%), such as α-fenchene, guaiol, globulol, α-muurolene, γ-himachalene, α-pinene, γ-elemene, and patchoulene.

A Realist Evaluation Analysis of a Novel Multi-Faceted Inpatient Patient Navigation Program.

OBJECTIVE: Children of color and from low-income families experience disparities in hospital care and outcomes. This study examined the experiences of parents and providers who participated in a novel patient navigation program designed to address these disparities. METHODS: Between April and October 2018, we conducted semistructured interviews with parents enrolled in the Family Bridge navigation pilot study, and inpatient care providers. Each set of interviews was thematically coded and analyzed according to the Realist Evaluation Framework of context, mechanism and outcomes; to identify how and when the program worked, for whom, and with what results. RESULTS: Of 60 parents enrolled in the intervention, 50 (83%) completed an interview. All enrolled children had public insurance; 66% were Hispanic, 24% were non-Hispanic Black, and 36% of parents preferred Spanish for communication. Of 23 providers who completed an interview, 16 (70%) were attending physicians. Parents identified 4 contexts influencing intervention effectiveness: past clinical experience, barriers to communication, access to resources, and timing of intervention delivery. Four mechanisms were identified by both parents and providers: emotional support, information collection and sharing, facilitating communication, and addressing unmet social needs. Parent-level outcomes included improved communication, feeling supported, and increased parental knowledge surrounding the child's care and the health system. Provider-level outcomes included providing tailored communication and attending to family nonmedical needs. CONCLUSIONS: This study provided insight into the mechanisms by which an inpatient navigation program may improve communication, support, and knowledge for parents of low-income children of color, both directly and by changing provider behavior.

Physicochemical Characterization and Paper Spray Mass Spectrometry Analysis of Myrciaria Floribunda (H. West ex Willd.) O. Berg Accessions.

Myrciaria floribunda, also known as rumberry, is a tree native to the Brazilian Atlantic Forest, where its fruits have the potential for commercial use. This study evaluates the antioxidant potential, determines the phytochemical profile, and chemically characterizes the rumberry fruit. Accessions were sampled from the Rumberry Active Germplasm Bank of the Federal University of Alagoas, Brazil. Physical characteristics, chemical characteristics, and phenolic compound content were analyzed. Chemical profile characterization was carried out using PSMS. Accessions had an average weight of 0.86 g. Accession AC137 presented a higher pulp yield (1.12 g). AC132 and AC156 had larger fruits, AC137 showed greater firmness (5.93 N), and AC160 had a higher and total phenolic content ratio (279.01 ± 11.11). Orange-colored accessions scored higher in evaluated parameters, except for AC160 for phenolic content. Thirty-two compounds were identified on positive ionization mode and 42 compounds on negative ionization mode using PSMS. Flavonoids, followed by the derivatives of benzoic acid, sugars, and phenylpropanoids, were the most prominent. Myricitrin, quercitrin, and catechin stand out as flavonoids that have been reported in previous studies with antioxidant and antimicrobial properties, in addition to health and therapeutical benefits, demonstrating the potential of the rumberry fruit.

Chemical Physical Characterization and Profile of Fruit Volatile Compounds from Different Accesses of Myrciaria floribunda (H. West Ex Wild.) O. Berg through Polyacrylate Fiber.

Among the many species of native fruit of Brazil that have been little explored, there is Myrciaria floribunda (also known as rumberry, cambuizeiro, or guavaberry), a species with significant variability, which has fruits of different colors (orange, red, and purple) when ripe. The physical-chemical characteristics evaluated were fruit weight (FW), seed weight (SW), pulp weight (PW), number of seeds (NS), longitudinal diameter (LD), transverse diameter (TD), format (LD/TD), hydrogen potential (pH), soluble solids (SS), titratable acidity (TA), and ratio (SS/TA); further, the volatile organic compounds (VOCs) of nine accesses of rumberry orchards were identified. The averages of the variables FW, SW, PW, NS, LD, TD, shape, and firmness were 0.76 g, 0.22 g, 0.54 g, 1.45, 10.06 mm, 9.90 mm, 1.02, 2.96 N, respectively. LD/TD data showed that the fruits have a slightly rounded shape (LD/TD = 1). The averages for pH, SS, TA, and SS/TA were 3.74, 17.58 Brix, 4.31% citric acid, and 4.31, respectively. The evaluated parameters indicated that the fruits can be consumed both in natura and industrialized, with the red-colored fruits presenting a good balance of SS/TA, standards demanded by the processing industries. Thirty-six VOCs were identified, with emphasis on the sesquiterpenes. Caryophyllene (21.6% to 49.3%) and γ-selinene (11.3% to 16.3%) were the most predominant compounds in rumberry fruits.

Views on the co-evolution of the melanocortin-2 receptor, MRAPs, and the hypothalamus/pituitary/adrenal-interrenal axis.

A critical regulatory component of the hypothalamus/pituitary/adrenal axis (HPA) in mammals, reptiles and birds, and in the hypothalamus/pituitary/interrenal (HPI) axis of amphibians and teleosts (modern bony fishes) is the strict ligand selectivity of the melanocortin-2 receptor (MC2R). Tetrapod and teleost MC2R orthologs can only be activated by the anterior pituitary hormone, ACTH, but not by any of the MSH-sized ligands coded in POMC. In addition, both tetrapod and teleost MC2R orthologs require co-expression with the accessory protein, MRAP. However, the MC2R ortholog of the elephant shark, a cartilaginous fish, can be activated by either ACTH or the MSH-sized ligands, and the elephant shark MC2R ortholog does not require co-expression with an MRAP for activation. Given these observations, this review will provide a scenario for the co-evolution of MC2R and MRAP, based on the assumption that the obligate interaction between MC2R and MRAP evolved during the early radiation of the ancestral bony fishes.

Histopathology of chronic kidney disease of unknown etiology in Salvadoran agricultural communities.

INTRODUCTION: For at least a decade, a chronic kidney disease unassociated with diabetes mellitus, hypertension or any of the more common traditional causes, has been reported in Salvadoran agricultural communities. OBJECTIVE: Characterize histopathology of chronic kidney disease of unknown etiology in patients from Salvadoran agricultural communities, describe renal damage associated with each disease stage, and assess associations between histopathological alterations and sociodemographic variables. METHODS: The study involved 46 patients of both sexes, aged =18 years. After clinical, laboratory and imaging examinations, kidney biopsies were performed and renal tissue assessed for interstitial fibrosis, tubular atrophy, interstitial inflammatory infiltration, sclerosis, increase in glomerular size and extraglomerular vascular lesions (according to the Banff 97 classification used for kidney transplant rejection). Special staining was done: Schiff periodic acid, Masson trichrome and methenamine silver. Immunofluorescence techniques were used to evaluate IgA, IgG, IgM, complement C1q and C3, fibrin, and kappa and lambda light chain deposits. RESULTS: The main findings were interstitial fibrosis and tubular atrophy with or without inflammatory monocyte infiltration. In addition, generalized sclerosis, increased glomerular size, collapse of some glomerular tufts, and lesions of extraglomerular blood vessels (such as intimal proliferation and thickening and vacuolization of the tunica media) were observed. Interstitial fibrosis and glomerulosclerosis were associated with male sex. Sugarcane workers showed more interstitial fibrosis and tubular atrophy and less glomerulomegaly than other occupational groups. CONCLUSION: The morphological pattern in all biopsies was one of chronic tubulointerstitial nephropathy with secondary glomerular and vascular damage, in different stages of evolution of chronic kidney disease, independent of age, sex or occupation.

Rehabilitación en fracturas del tercio medio de clavícula operadas con clavo Hunec / Rehabilitation of clavicle fractures after surgical treatment by Hunec intramedullary pinning

Las fracturas de clavícula del tercio medio de la clavícula tratadas con clavo Hunec pueden iniciar la rehabilitación inmediatamente después de la cirugía, por que es un implante que permite la movilidad articular del hombro, por lo tanto fortalecimiento inmediato. Se estudiaron 35 pacientes, con edad promedio de 29 años, 30 masculinos (86 por ciento) y 5 femeninos (14 por ciento), la ocupación de mayor porcentaje fue el hogar 15 por ciento y estudiante 29 por ciento. Los arcos de movilidad fueron completos y la fuerza muscular normal. La integración de las actividades de la vida diaria 3 días (56 por ciento) y laboral en 15 a 20 días, posterior a la cirugía. Prueba t de Student p<0.05 para arcos de movilidad y fuerza muscular. Discusión. La rehabilitación inicia con la selección del implante de acuerdo a la clasificación de las fracturas ya que permite hacer un programa de atención, que logre integrar al paciente a su vida laboral tempranamente. Conclusión. El clavo Hunec en las fracturas de clavícula permite integrar a las actividades de la vida diaria y de trabajo antes de 20 días