The Impact of Language on Hospital Outcomes for COVID-19 Patients: A Study of Non-English Speaking Hispanic Patients.

BACKGROUND: The COVID-19 pandemic has highlighted and exacerbated health inequities, as demonstrated by the disproportionate rates of infection, hospitalization, and death in marginalized racial and ethnic communities. Although non-English speaking (NES) patients have substantially higher rates of COVID-19 positivity than other groups, research has not yet examined primary language, as determined by the use of interpreter services, and hospital outcomes for patients with COVID-19. METHODS: Data were collected from 1,770 patients with COVID-19 admitted to an urban academic health medical center in the Chicago, Illinois area from March 2020 to April 2021. Patients were categorized as non-Hispanic White, non-Hispanic Black, NES Hispanic, and English-speaking (ES) Hispanic using NES as a proxy for English language proficiency. Multivariable logistic regression was used to compare the predicted probability for each outcome (i.e., ICU admission, intubation, and in-hospital death) by race/ethnicity. RESULTS: After adjusting for possible confounders, NES Hispanic patients had the highest predicted probability of ICU admission (p-value < 0.05). Regarding intubation and in-hospital death, NES Hispanic patients had the highest probability, although statistical significance was inconclusive, compared to White, Black, and ES Hispanic patients. CONCLUSIONS: Race and ethnicity, socioeconomic status, and language have demonstrated disparities in health outcomes. This study provides evidence for heterogeneity within the Hispanic population based on language proficiency that may potentially further contribute to disparities in COVID-19-related health outcomes within marginalized communities.

Spanish-Speaking Patients Have Limited Access Scheduling Outpatient Orthopaedic Appointments Compared With English-Speaking Patients Across the United States.

Purpose: To evaluate whether Spanish-speaking patients can obtain appointments to outpatient orthopaedic surgery clinics across the United States at a similar rate as English-speaking patients and to examine the language interpretation services available at those clinics. Methods: Orthopaedic offices nationwide were called by a bilingual investigator to request an appointment with a pre-established script. The investigators called in English asking for an appointment for an English-speaking patient (English-English), called in English requesting an appointment for a Spanish-speaking patient (English-Spanish), and called in Spanish asking for an appointment for a Spanish-speaking patient (Spanish-Spanish) in a random order. During each call whether an appointment was given, the number of days to the offered appointment, the mechanism of interpretation available in clinic, and whether the patient's citizenship or insurance information was requested was collected. Results: A total of 78 clinics included in the analysis. There was a statistically significant decrease in access to scheduling an orthopaedic appointment in the Spanish-Spanish group (26.3%) compared with English-English (61.3%) or English-Spanish (58.8%) groups (P < .001). There was no significant difference in access to appointment between rural and urban areas. Patients in the Spanish-Spanish group who made an appointment were offered in-person interpretation 55% of the time. There was no statistically significant difference in time from call to offered appointment or the request for citizenship status between the 3 groups. Conclusions: This study detected a considerable disparity regarding access to orthopaedic clinics nationwide in the individuals who called to establish an appointment in Spanish. Patients in the Spanish-Spanish group were able to make an appointment less often but had in-person interpreters available for interpretation services. Clinical Relevance: With a large Spanish-speaking population in the United States, it is important to understand how lack of proficiency with the English language may affect access to orthopaedic care. This study uncovers variables associated with difficulties scheduling appointments for Spanish-speaking patients.

Integrating a problem-solving intervention with routine care to improve psychosocial functioning among mothers of children with sickle cell disease: A randomized controlled trial.

OBJECTIVE: To assess the feasibility of a problem-solving skills training intervention in improving psychological outcomes in mothers of infants with sickle cell disease (SCD). DESIGN AND METHODS: This parallel randomized controlled trial recruited 64 babies with SCD, 6 to 12 months of age, and their mothers. Baseline measurements assessed mothers' coping and problem-solving skills, depression, and parental stress before random assignment to intervention or control groups (n = 32 each). Problem-solving skills intervention was delivered through 6 monthly sessions, when babies attended for routine penicillin prophylaxis. All measurements were repeated for both groups at the end of the intervention period. Intention to treat analysis used repeated measures mixed models with the restricted estimation maximum likelihood approach. RESULTS: The problem-solving intervention had no significant effect on mothers' problem-solving skills (adjusted treatment effect: -1.69 points (95% CI:-5.62 to 2.25)), coping behaviours (adjusted treatment effect: 0.65 points (95% CI:- -7.13 to 8.41)) or depressive symptoms (adjusted treatment effect: -0.41 (95% CI: -6.00 to 5.19)). It reduced mothers' level of difficulty in managing stressful events by 9.5 points (95% CI (-16.86 to -2.16); effect size: 0.21 SD). In the subgroup of mothers at risk of depression (n = 31 at baseline), the intervention reduced depression scores with treatment effect of 10.4 points (95%CI: -18.83 to -1.88; effect size: 0.67 SD). CONCLUSION: This problem-solving skills intervention study suggests feasibility and possible efficacy in improving some maternal outcomes. Further refinement and culturally appropriate adaptations of the intervention could lead to stronger effects.

A home visit-based early childhood stimulation programme in Brazil-a randomized controlled trial.

Home visiting programmes are increasingly recognized as one of the most effective interventions to improve child health and development in low-income settings. However, the best platforms to deliver such programmes remain unclear. We conducted a randomized controlled trial to test the relative effectiveness of child development agents (CDAs) and community health workers (CHWs) as two possible delivery platforms for early childhood development (ECD) focused home visiting intervention in São Paulo, Brazil. A total of 900 children aged 9-15 months were screened for potential study inclusion between January and March 2015. Children who did not attend crèches at enrolment were included in the trial. Children were randomly assigned to control or to receive biweekly home visits either through a CHW in the areas covered by the Brazilian Family Health Strategy (FHS) or by a newly hired cadre of CDAs in the areas not covered by the FHS. The primary study outcome was children's development (cognition, motor, language and social emotional skills) assessed after 12 months of intervention with the PRIDI and Caregiver-Reported Early Development Instruments tools. A total of 826 mother-child dyads were enrolled in the trial. In intention-to-treat analysis, neither intervention arm improved study outcomes. In per-protocol (PP) analysis, the CDA programme resulted in a 0.22 standard deviation increase in children's development (95% confidence interval [0.01-0.43]). The results presented in this study suggest that home visiting programmes have the potential to improve child development among poor urban families in Brazil. However, delivering home visiting interventions through already active CHWs may not be feasible in the Brazilian context and coordination across sectors is essential to effective ECD policies.

Contact Between Adoptive and Birth Families: Perspectives from the Minnesota Texas Adoption Research Project.

A growing number of adoptive families have contact with their children's birth relatives. The Minnesota Texas Adoption Research Project is examining longitudinally the consequences of variations in contact arrangements for birth mothers, adoptive parents, and adopted children in domestic infant adoptions, and is studying the dynamics of relationships within these family systems. Individuals who had contact were more satisfied with their arrangements than those who did not have contact. Satisfaction with contact predicted more optimal adjustment among adopted adolescents and emerging adults. Adoption-related communication predicted identity development among adopted adolescents and emerging adults. Birth mothers who were more satisfied with their contact arrangements, regardless of level of contact, had less unresolved grief 12 to 20 years after placement. Adoptive and birth relatives who engage in contact need flexibility, strong interpersonal skills, and commitment to the relationship. These skills can be learned, and they can be supported by others, through informal, psychoeducational, and therapeutic means.

Obesity care strategies in primary care practices.

We evaluated pediatric obesity clinics for internal referrals developed at 5 primary care offices. Clinics developed site-specific strategies: 1 group approach and 4 clinics providing individualized care only. Clinicians reported patient/family motivation as an important referral consideration and compliance as the greatest challenge and perceive clinics to have provided some help.

Postplacement relationships between birth mothers and their romantic partners.

Using a mixed-methods approach, the understudied population of birth mothers who placed their infants for adoption 12-20 years ago was explored in the context of their romantic relationships. In a semistructured interview, 104 birth mothers answered detailed questions about their romantic relationships and adoption-related experiences. All birth mothers had disclosed the adoption placement to their romantic partners, and most had done so early because they wanted to be truthful about their past. On average, the birth mothers were satisfied with their romantic relationships and almost half did not believe that the adoption had affected it. Regarding contact in the adoption, a majority of the birth mothers' romantic partners (63.5%) were not directly involved in contact with the adoptive family or adopted youth. Implications about how adoption is perceived and processed within intimate relationships are discussed.

Efecto del sitio de deposición del plasma seminal sobre la tasa de ovulación y formación del cuerpo lúteo en alpacas / Effect of the deposition site of seminal plasma on the ovulation and corpus luteum development in alpacas

El estudio tuvo por objetivo evaluar el sitio de deposición del plasma seminal sobre la tasa de ovulación y formación del cuerpo lúteo en alpacas. Se seleccionaron 91 hembras no lactantes con folículos .7 mm detectados por ecografía transrectal. Se sincronizola onda folicular con la aplicación de 5 mg de LH, y 12 días después, se determinó la presencia de un folículo dominante (.7 mm). Las hembras se distribuyeron al azar en seis tratamientos: G1 =16 (Plasma seminal vía intramuscular), G2=15 (PBS vía intramuscular), G3=16 (Plasma seminal vía intrauterina), G4=15 (PBS vía intrauterina), G5 =15 (Plasma seminal vía intrauterina con curetaje), G6 =14 (PBS vía intrauterina con curetaje). La tasa de ovulación y presencia de cuerpo lúteo se determinó mediante ecografía el día D2 y D8 (D0 = inicio del tratamiento). Se tomó muestras de sangre los días D0, D3 y D9 para determinar perfiles séricos de progesterona mediante RIA. La tasa de ovulación fue de 93.8, 37.5 y 66.5% para G1, G3 y G5, respectivamente, y no se registraron ovulaciones en los otros grupos. Se encontró que las alpacas G1 producirían 25 veces más ovulaciones con respecto al G3. Los resultados sugieren que la absorción del factor inductor de ovulación (FIO) del plasma seminal es vía sistemica y que el curetaje facilitaría la absorción del FIO incrementando el efecto ovulatorio del plasma seminal.

The present study was carried out to evaluate the effect of deposition site of seminal plasma on the ovulation rate and size of corpus luteum in alpacas. Non-lactating females bearing a .7 mm follicle detected by ultrasound were selected (n = 91). Follicular wave was synchronized by injecting 5 mg of LH and then, the presence of a dominant follicle .7 mm was determined 12 days later through ultrasound evaluation. Alpacas were assigned to one of six experimental groups: G1 (n=16) seminal plasma (SP) by intramuscular injection . i.m.; G2 (n=15) phosphate-buffered saline (PBS) i.m.; G3 (n=16) SP by intrauterine administration . i.u.; G4 (n=15) PBS i.u.; G5 (n=15) SP i.u. with curettage; G6 (14) PBS by i.u. with curettage. Ovulation rate and corpus luteum were determined by ultrasound evaluation on D2 and D8 (D0 = day of treatment). Serum samples were taken from the jugular vein on D0, D3 and D9 to determine progesterone profiles by radioimmunoassay. Ovulation rate was 93.7, 37.5, and 66.5% for G1, G3 and G5 respectively, while none ovulations were observed in the other three groups. Alpacas in G1 would produce 25 more ovulations than G3. Results of the present study suggested that the ovulation-inducing factor (OIF) present in seminal plasma is absorbed systemically and that the mechanical action of curettage would contribute to the absorption of the OIF present in seminal plasma.

Relación entre el tamaño de los macroquistes de Sarcocystis aucheniae y su viabilidad en Canis familiaris / Relationship between the size of macrocysts of Sarcocysistis Aucheniae and its viability in Canis Familiaris

El objetivo del estudio fue determinar si el tamaño de los macroquistes de Sarcocystis aucheniae afectan la viabilidad y potencial biótico en los caninos domésticos. Se utilizaron 24 cachorros cruzados de 2.5 meses de edad, con pesos promedio de 2.6 kg., debidamente desparasitados y alimentados con una dieta casera exenta de carnes. Se obtuvo macrosquistes de S. aucheniae del cuello de alpacas y llamas en un camal local, clasificándolos en macroquistes grandes (>5 mm) y pequeños (1-3 mm). Diez cachorros fueron oralmente infectados con 500 macroquistes grandes (MG) y 12 cachorros con 500 macroquistes pequeños (MP), en ambos casos por dos días consecutivos. Además, 6 perros quedaron sin infectar como grupo control. Se recolectó diariamente muestras fecales a partir del 8º día post-infección y por un periodo de 22 días. Las muestras se analizaron por el método de flotación con solución de Sheather para determinar la presencia de ooquistes o esporoquistes de Sarcocystis sp. y el método de Stoll modificado para cuantificar su número por gramo de heces. Los resultados mostraron que animales infectados con MP presentaron una carga de esporoquistes 3.6 veces superior que aquellos infectados con MG; así mismo, el periodo prepatente promedio fue de 16.5 y 11.5 para los MG y MP, respectivamente.

The objective of the study was to determine weather the size of Sarcocystis aucheniae macrocysts affect its viability and biotic potential in domestic canines. A total of 26 crossbred puppies, 2.5 month of age, 2.6 kg of body weight, were used. Puppies were dewormed and fed with a diet extent of meat. Macrocysts of S. aucheniae were obtained from alpaca and llama´s neck in the local slaughterhouse. Cysts were classified according to size in large (>5 mm) and small (1-3 mm) cysts. Ten puppies were orally infected with 500 large macrocysts (MG) and 12 puppies with 500 small macrocysts (MP), for 2 consecutive days, whereas 6 puppies were kept as controls. Fecal samples were daily collected and analyzed by the flotation method using the Sheather solution to determinethe presence of oocysts and sporocysts of Sarcocystis sp. and the modified Stoll method to quantify the number of sporocysts per gram of feces. The results showed that the burden of sporocysts was 3.6 times more in puppies infected with MP than in those infected with MG. Furthermore, the average prepatent period was 16.5 and 11.5 days for MG and MP respectively.

Frecuencia de Sarcocystis sp. en perros pastores de asociaciones alpaqueras de Maranganí, Cusco / Frequency of Sarcocystis sp. in sheepdogs from alpaca association breeders, Maranganí, Cusco

El objetivo del estudio fue determinar la frecuencia de Sarcocystis sp. en perros pastores de asociaciones alpaqueras del distrito de Maranganí, Cusco, durante las dosépocas del año (seca y lluviosa). El trabajo se realizó entre abril de 2005 y febrero de 2006. Se colectaron 211 muestras fecales de perros pastores de los productores alpaqueros dela zona. Las heces fueron analizadas mediante el método de flotación con solución de Sheather para determinar la presencia de ooquistes o esporoquistes de Sarcocystis sp. Se encontró una frecuencia de 42.3 ± 9.2% (47/111) y 72.0 ± 8.8% (72/100) en la época seca y lluviosa, respectivamente. Los resultados muestran una asociación significativa entre la tasa de infección y la época del año (p<0.05). El mes de noviembre presentó la mayor tasa (77.8 ± 12.1%, 35/49) y en mayo se obtuvo la menor tasa (17.6 ± 12.8%, 6/34). Además, se encontró diferencias significativas entre grupos etáreos (p<0.05).

The aim of the study was to determine the frequency of Sarcocystis spp. in sheepdogs of alpaca farm associations at Maranganí, Cusco, during the dry and rainy season (April 2005 until February 2006). Fecal samples (n = 211) were collected and evaluated using the method of flotation with Sheather solution to observe sporocysts of Sarcocystis spp. The frequency during the dry and rainy season was 42.3 ± 9.2% (47/111) and 72.0 ± 8.8% (72/100) respectively. The results showed an association between the rate of infection and the time of the year (p<0.05), where November had the highest rate (77.8 ± 12.1%, 35/45) and March had the lowest (17.6 ± 12.8%, 6/34). In addition, significant difference was found due to age of the dog (p<0.05).

Processes linked to contact changes in adoptive kinship networks.

The purpose of this study was to reveal underlying processes in adoptive kinship networks that experienced increases or decreases in levels of openness during the child's adolescent years. Intensive case study analyses were conducted for 8 adoptive kinship networks (each including an adoptive mother, adoptive father, adopted adolescent, and birth mother), half of whom had experienced an increase in openness from indirect (mediated) to direct (fully disclosed) contact and half of whom had ceased indirect contact between Waves 1 and 2 of a longitudinal study. Adoptive mothers tended to be more involved in contact with the birth mother than were adoptive fathers or adopted adolescents. Members of adoptive kinship networks in which a decrease in level of contact took place had incongruent perspectives about who initiated the stop in contact and why the stop took place. Birth mothers were less satisfied with their degree of contact than were adoptive parents. Adults' satisfaction with contact was related to feelings of control over type and amount of interactions and permeability of family boundaries. In all adoptive kinship networks, responsibility for contact had shifted toward the adopted adolescent regardless of whether the adolescent was aware of this change in responsibility.

Increasing trends in elderly persons' use of nonvitamin, nonmineral dietary supplements and concurrent use of medications.

OBJECTIVE: Use of nonvitamin, nonmineral dietary supplements among an elderly cohort was surveyed to determine which were the most frequently used, and to report potential medication/supplement interactions observed. DESIGN: A retrospective review of the use of 22 supplements and prescription/over-the-counter medications was collected annually from 1994 to 1999. SUBJECTS/SETTING: Supplement and medication records for an average of 359 male (36%) and female (64%) participants aged 60 to 99 years were reviewed annually. Ethnic distribution was 91% non-Hispanic white, 7% Hispanic, 1% Asian, and 1% African American. STATISTICAL ANALYSES PERFORMED: Descriptive statistics generated included mean, standard deviation, and frequency by percentage. To compare supplement user and nonsupplement user percentages across age groups, the chi 2 test was used. Linear regression was performed to test for longitudinal usage trends of each individual supplement. RESULTS: By 1999, glucosamine emerged as the most frequently used nonvitamin, nonmineral supplement followed by ginkgo biloba, chondroitin, and garlic. For women, there was a significant linear trend ( P < .05) over time for these 12 supplements: black cohosh, borage, evening primrose, flaxseed oil, chondroitin, dehydroepiandrosterone, garlic, ginkgo biloba, glucosamine, grapeseed extract, hawthorn, and St John's wort. For men, three supplements (alpha lipoic acid, ginkgo biloba, and grape-seed extract) showed a significant linear trend ( P <.05). Potential interactions between supplements and medications were seen for 10 of the 22 supplements surveyed, with a total of 142 potential interactions observed over the 6-year period. CONCLUSIONS: Examining nonvitamin, nonmineral supplement use in combination with prescription/over-the-counter medications in elderly persons is important to identify the potential risks of interactions.

Changes in dietary intake after diagnosis of breast cancer.

OBJECTIVE: To quantify change in intake of kilocalories, macronutrients, and fruit and vegetable servings after diagnosis of breast cancer, and to correlate these changes with subject characteristics and with self-reported global change in dietary patterns. DESIGN: Food frequency questionnaires were completed by women newly diagnosed with breast cancer shortly after diagnosis. They were asked to recall intake 1 year before diagnosis. Two years after the initial interview another food frequency questionnaire was completed recalling intake during the previous year. At the 2-year follow-up interview women were also asked if they had changed their intake of fruit, vegetables, and fat since diagnosis. SUBJECTS/SETTING: Two hundred sixty New Mexico women with newly diagnosed breast cancer between July 1997 and March 1999. ANALYSIS: Two-year change scores for kilocalories, macronutrients, and fruit and vegetable servings were calculated and tested for difference from zero using paired t tests or Wilcoxon signed rank tests. Subjects' characteristics were related to change in kilocalories and linear regression was used to determine the relative importance of these characteristics. Amount of change in fruit and vegetable servings and fat intake were calculated using food frequency data for women who reported increasing their intake of fruits and vegetables or decreasing their intake of fat after diagnosis. RESULTS: Small but significant decreases in intake of total energy and macronutrients were found 2 years postdiagnosis, with younger women reporting the greatest decreases. Fat as a percentage of diet increased over this period. There was no change in mean intake of fruit and vegetable servings. There is agreement between change as measured by food frequency questionnaire and change reported by more global questions on dietary habits; however, the amount of change measured was small. Women reporting an increase in fruit and vegetable intake postdiagnosis described an increase of one-quarter serving of fruit and one-third serving of vegetables per day. CONCLUSIONS: Breast cancer diagnosis results in modest dietary changes. Small changes in fruit and vegetable consumption suggest that efforts are needed to encourage increased consumption of these foods.

New Linear Coordination Polymers Based on Copper(I) and 4,7-Phenanthroline: Structure Dependence on Solvent and Counteranion.

Three new linear coordination polymers containing Cu(I) and 4,7-phenanthroline (phen) have been synthesized and structurally characterized by single-crystal X-ray diffraction. [Cu(phen)(MeCN)(2)]PF(6) (3) and [Cu(phen)(MeCN)]BF(4) (4) are prepared from acetonitrile, and [Cu(phen)(BzCN)]BF(4) (5) is made from benzonitrile (MeCN = acetonitrile; BzCN = benzonitrile). All of the compounds have linear polymeric structures containing Cu(I) centers coordinated by two bridging 4,7-phenanthroline ligands, with additional coordinated solvent molecules completing the copper coordination sphere. In 3 and 4, when acetonitrile is used, two and one MeCN solvent molecules coordinate to each Cu atom, resulting in a distorted tetrahedral and distorted trigonal geometry, respectively. The major interchain interactions are phenanthroline pi-pi stacks. When benzonitrile is used in 5, the chain-packing motif changes to allow the coordinated benzonitrile ligands to participate in the interchain pi-pi stacking. Crystal data: for [Cu(phen)(MeCN)(2)]PF(6) (3), monoclinic, space group P2(1)/c (No. 14), with a = 11.4303(6) Å, b = 11.4954(6) Å, c = 14.0444(7) Å, beta = 99.948(1) degrees, and Z = 4; for [Cu(phen)(MeCN)]BF(4) (4), monoclinic, space group P2(1)/c (No. 14), with a = 8.7677(5) Å, b = 11.5140(7) Å, c = 14.8858(9) Å, beta = 96.548(1) degrees, and Z = 4; for [Cu(phen)(BzCN)](2)2BF(4) (5), triclinic, space group P&onemacr; (No. 2), with a = 11.338(1) Å, b = 12.461(1) Å, c = 13.904(1) Å, alpha = 115.909(2) degrees, beta = 100.870(2) degrees, gamma = 92.052(2) degrees, and Z = 2.