Using the multiphase optimization strategy (MOST) framework to optimize an intervention to increase COVID-19 testing for Black and Latino/Hispanic frontline essential workers: A study protocol.

BACKGROUND: Among those at highest risk for COVID-19 exposure is the large population of frontline essential workers in occupations such food service, retail, personal care, and in-home health services, among whom Black and Latino/Hispanic persons are over-represented. For those not vaccinated and at risk for exposure to COVID-19, including frontline essential workers, regular (approximately weekly) COVID-19 testing is recommended. However, Black and Latino/Hispanic frontline essential workers in these occupations experience serious impediments to COVID-19 testing at individual/attitudinal- (e.g., lack of knowledge of guidelines), social- (e.g., social norms), and structural-levels of influence (e.g., poor access), and rates of testing for COVID-19 are insufficient. METHODS/DESIGN: The proposed community-engaged study uses the multiphase optimization strategy (MOST) framework and an efficient factorial design to test four candidate behavioral intervention components informed by an integrated conceptual model that combines critical race theory, harm reduction, and self-determination theory. They are A) motivational interview counseling, B) text messaging grounded in behavioral economics, C) peer education, and D) access to testing (via navigation to an appointment vs. a self-test kit). All participants receive health education on COVID-19. The specific aims are to: identify which components contribute meaningfully to improvement in the primary outcome, COVID-19 testing confirmed with documentary evidence, with the most effective combination of components comprising an "optimized" intervention that strategically balances effectiveness against affordability, scalability, and efficiency (Aim 1); identify mediators and moderators of the effects of components (Aim 2); and use a mixed-methods approach to explore relationships among COVID-19 testing and vaccination (Aim 3). Participants will be N = 448 Black and Latino/Hispanic frontline essential workers not tested for COVID-19 in the past six months and not fully vaccinated for COVID-19, randomly assigned to one of 16 intervention conditions, and assessed at 6- and 12-weeks post-baseline. Last, N = 50 participants will engage in qualitative in-depth interviews. DISCUSSION: This optimization trial is designed to yield an effective, affordable, and efficient behavioral intervention that can be rapidly scaled in community settings. Further, it will advance the literature on intervention approaches for social inequities such as those evident in the COVID-19 pandemic. TRIAL REGISTRATION: ClinicalTrials.gov: NCT05139927 ; Registered on 11/29/2021. Protocol version 1.0. May 2, 2022, Version 1.0.

Community education to enhance the more equitable use of precision medicine in Northern Manhattan.

Focusing screening and treatment to those most likely to benefit is the promise of precision medicine but inequitable distribution of precision medicine innovations may exacerbate health disparities. We investigated whether complex genomic concepts can be successfully communicated to diverse populations. Incorporating principles of Community-based Participatory Research, we created a precision medicine curriculum tailored to the needs of our predominantly Hispanic community. We administered the curriculum over 26 months, assessed pre- and post-test comprehension of 8 genetics-related terms, and compared comprehension differences based on demography and health literacy. In total, 438 individuals completed pre-/post-test assessments. At pre-test, 45.6% scored ≥75% across eight major constructs; 66.7% at post-test. Comprehension increased for 7/8 terms with greatest pre/post-test increases for 'mutation' (55% to 78%) and 'sporadic' (34% to 59%). Mean pre-test comprehension scores (≥75%) were lower for Spanish versus. English speakers; mean post-test scores were equivalent. No heterogeneity by demographics or health literacy was observed. We demonstrate that a brief community educational program can improve knowledge of complex genomic concepts. Interventions to increase understanding of genomic concepts underlying precision medicine are key to patients making informed treatment and prevention decisions and may lead to more equitable uptake of precision medicine initiatives.

Electronic Communication Channel Use and Health Information Source Preferences Among Latinos in Northern Manhattan.

Understanding key health concepts is crucial to participation in Precision Medicine initiatives. In order to assess methods to develop and disseminate a curriculum to educate community members in Northern Manhattan about Precision Medicine, clients from a local community-based organization were interviewed during 2014-2015. Health literacy, acculturation, use of Internet, email, and text messaging, and health information sources were assessed. Associations between age and outcomes were evaluated; multivariable analysis used to examine the relationship between participant characteristics and sources of health information. Of 497 interviewed, 29.4 % had inadequate health literacy and 53.6 % had access to the Internet, 43.9 % to email, and 45.3 % to text messaging. Having adequate health literacy was associated with seeking information from a healthcare professional (OR 2.59, 95 % CI 1.54-4.35) and from the Internet (OR 3.15, 95 % CI 1.97-5.04); having ≤ grade school education (OR 2.61, 95 % CI 1.32-5.17) also preferred information from their provider; persons >45 years (OR 0.29, 95 % CI 0.18-0.47) were less likely to use the Internet for health information and preferred printed media (OR 1.64, 95 % CI 1.07-2.50). Overall, electronic communication channel use was low and varied significantly by age with those ≤45 years more likely to utilize electronic channels. Preferred sources of health information also varied by age as well as by health literacy and educational level. This study demonstrates that to effectively communicate key Precision Medicine concepts, curriculum development for Latino community members of Northern Manhattan will require attention to health literacy, language preference and acculturation and incorporate more traditional communication channels for older community members.

Community health workers as drivers of a successful community-based disease management initiative.

In 2005, local leaders in New York City developed the Washington Heights/Inwood Network for Asthma Program to address the burden of asthma in their community. Bilingual community health workers based in community organizations and the local hospital provided culturally appropriate education and support to families who needed help managing asthma. Families participating in the yearlong care coordination program received comprehensive asthma education, home environmental assessments, trigger reduction strategies, and clinical and social referrals. Since 2006, 472 families have enrolled in the yearlong program. After 12 months, hospitalizations and emergency department visits decreased by more than 50%, and caregiver confidence in controlling the child's asthma increased to nearly 100%. Key to the program's success was the commitment and involvement of community partners from program inception to date.

Lipoproteína de baja densidad pequeña y densa y riesgo cardiovascular en pacientes con lupus eritematoso sistémico / Low density lipoprotein and cardiovascular risk factors in patients with systemic lupus erythematosus

Las enfermedades cardiovasculares (ECV) constituyen la principal causa de morbi-mortalidad en pacientes con lupus eritematoso sistémico (LES). Un factor de riesgo cardiovascular es la dislipidemia, siendo una alteración frecuente en es tos pacientes , caracterizada por incremento de lipoproteín as de b aja densidad ; cuyo fenotipo pe queñas y densas (LDLpd ) ha demostrado ser altamente aterogénico. El objetivo del presente estudio fue evaluar la presencia de LDLpd y factores clásicos de riesgo cardiovascular en pacientes con LES. La muestra estuvo constituida por 24 pacientes con LES y 24 individuos sin patología aparente (Control, CTR). Se midió la presión arterial, se determinó índice de masa corporal (IMC), í ndice cintura cadera (ICC), colesterol total y fraccionado, triglicéridos y se detectó LDLpd mediante electroforesis en gel de a garosa. Al comparar el grupo LES vs CTR se encontró diferencia estadísticamente significativa con presión arterial diastólica (77,45±7,98 mmHg vs 86,6±9,16 mmHg, p=0,00 006), ICC (0,82 ± 0,09 v s 0,86 ± 0,05, p=0,0174), IMC (25,93 ± 5,16 vs 30,15± 6,64, p=0, 036), HDL-c (47,75 ± 7,74 mg/dL vs 53,16± 5,49 mg/dL, p= 0,0134), VLDL-c (23,57 ± 13,01 vs 14,79 ± 5,47 mg/dL, p=0,0002) y triglicéridos (117,8 ± 65,08 vs 73,95 ± 27,35 mg/dL, p=0,0002). La presencia de LDLpd en ambos grupos de estudio se encontró en parámetros del perfil lipidico y/o antropométricos dentro de los valores de referencia y/o elevados. Estos resultados sugieren que un individuo con LES o no , que presente variables que constituyen el perfil lipidico y /o parámetros antropométrico s d entro de los valores de referencia, no lo excluye de desarrollar o presentar un evento cardiovascular.

Cardiovascular diseases are the main cause of morbidity and mortality in patients with systemic lupu s erythematosus (SLE). A car diovascu lar risk factor is dyslipidemia, being a frequen t altera tion in these pa tients, characte rized by increas e of lipoprotein of low density; whose small and dense phenotype (LDLsd) has been shown to be highly athe rogenic. The aim of the prese nt study was to e valuate the presen ce of LDLsd and classic ca rdiovascu lar risk factors in patie nts with S LE. The s ample consisted of 24 patients with SLE and 24 individuals with no apparent disease. Blood pressure was me asured, body mass index (BMI), waist circumference (ICC), lipid profile (total cholesterol, HDL cholesterol, LDL cholesterol, VLDL cholesterol and triglycerides) were determined and LDLsd was detected by agarose gel electrophoresis. When comparing the SLE vs CTR group, a statistically significant difference was found with diastolic blood pressure (77.45±7,98 mmHg vs 86.6±9,16 mmHg, p =0.00006), ICC (0.82 ± 0.09 vs 0.86 ± 0.05, p=0.0174), BMI (25.93 ± 5.16 vs 30.15± 6.64, p=0.036), HDL-c (47.75 ± 7.74 mg/ dL vs 53.16± 5.49 mg/ dL, p= 0.0134), VLDL-c (23.57 ± 13.01 vs 14.79 ± 5.47 mg/dL, p=0.0002) and triglycerides (117.8 ± 65 .08 vs 73.95 ± 27.35 mg/ dL, p=0.0002). The presence of LDLsd in both study groups was found lipidic profile and/or anthropom etrics parameters within the reference and/or elevated values. This result suggests that an individual with SLE or not, which presents variables that constitute the lipid profile and / or anthropometric parameters within the reference values, does not exclude it from developing or presenting a cardiovascular event.

Niveles de testosterona total y libre en individuos con síndrome metabólico / Levels of total and free testosterone in individuals with metabolic sindrome

EL síndrome metabólico es un conjunto de factores de riesgo de origen metabólico que pueden aparecer de manera simultánea o secuencial en un mismo individuo, el SM es causado por la combinación de factores genéticos y factores asociados al estilo de vida, especialmente la sobrealimentación y la ausencia de actividad física, que promueven a su vez el desarrollo de enfermedades cardiovasculares (ECV) y otras patologías como la diabetes, enfermedad coronaria y cerebro vascular.. Entre los factores indirectos del síndrome metabólico, se ha establecido recientemente los niveles bajos de te stosterona como factor desencadenante en hombres. De allí que se desarrolló la presente investigación con el objeto de relacionar los niveles séricos de testosterona total y libre con el síndrome metabólico y sus criterios, en la población masculina. Para ello se determinaron los parámetros clínicos (presión arterial, circunferencia abdominal) y bioquímicos (glucemia basal, HDL-Colesterol, Triglicéridos ) que evalúan el síndrome metabólico asi como los niveles de Testosterona Total y Ligada . Resultados: los niveles de testosterona total y libre, son inferiores en el grupo de pacientes con síndrome metabólico, sin embargo al determinar la significancia estadística mediante la t de Student, no se aprecia diferencia en los valores promedio de testosterona total (sig 0,08) más si en los valores promedio de testosterona libre (sig 0,000). Ambas (testosterona total y libre) se correlacionan significativamente de manera inversa con la obesidad abdominal. Los niveles de testosterona libre se relacionan inversa y significativamente con la edad.

The Metabolic syndrome is a cluster of risk factors of metabolic origin that may occur simultaneously or sequentially in the same individual, the SM is caused by a combination of genetic factors and factors related to lifestyle, especially overeating and lack physical activity, which in turn promote the development of cardiovascular disease (CVD) and other diseases such as diabetes, heart disease and cerebrovascular .. Indirect factors of metabolic syndrome, was recently established low levels of testosterone as a factor trigger in men. Hence, this research was conducted in order to relate the serum total and free testosterone with metabolic syndrome and its criteria in the male population. For this clinical parameters (blood pressure, abdominal circumference) and biochemical (fasting glucose, HDL-cholesterol, triglycerides) evaluating the metabolic syndrome as well as Total Testosterone levels were determined and Bound. Results: The levels of total and free testosterone are lower in the group of patients with metabolic syndrome, however to determine statistical significance using Student's t, no difference was seen in the average values of total testosterone (sig 0.08 ) more if in the mean values of free testosterone (sig 0.000). Both (total and free testosterone) was significantly inversely correlated with abdominal obesity. Free testosterone levels are associated inversely and significantly with age.

Factores de riesgo convencionales, no convencionales y lúpicos para ateroesclerosis en pacientes con lupus eritematoso sistémico / Conventional risk factors, unconventional and lupus for atherosclerosis in patients with systemic lupus erythematosus

El lupus eritematoso es un desorden inmune multisistémico e inflamatorio crónico que esta asociado con el desarrollo prematuro y severo de ateroesclerosis permitiendo de este modo colocar a las enfermedades cardiovasculares como la principal causa de morbi-morbilidad en pacientes con dicha enfermedad. La presente investigación se propuso, evaluar los factores de riesgo convencionales, no convencionales y lúpicos en pacientes con lupus eritematoso sistematico que contribuyen al desarrollo de ateroesclerosis. Para ello, a los pacientes (femenino n=14 y masculino n=1) se le realizaron las siguientes determinaciones: índice de masa corporal (IMC), circunferencia abdominal (CA), perfil lipídico (colesterol, HDL-c, LDL-c, VLDLc y triglicéridos), ácido úrico, velocidad sedimentación globular (VSG) y fibrinógeno. Donde se encontró, 85,71% (12/15) y 100% (14/15) de las pacientes padecían obesidad, ya que presentaron valores elevados del IMC (38,20±5,30 kg/mm2) y de CA(92,32±7,25 cm), respectivamente; 100% (15/15) baja concentraciones sérica de HDL-c (26,00±13,03 mg/dL); 93,33% (14/15) mostraron un estilo de vida sedentario; 33,33% (5/15) eran hipertensos diagnosticados y con tratamiento hipotensor, 33,33% (5/15) presentaban antecedentes familiares de enfermedad cardiovascular 6,66% (1/ 15) niveles elevados de VLDL-c; 6,66% (1/15) hipertrigliceridemia. También se encontró que 20% (3/15) presentaron hiperfibrinogenemia (434,50±38,90 mg/dL), 26,66% (4/15) hiperuricemia (10,46±2,45 mg/dL) y 100% presentó valores por encima del rango de referencia para la VSG. Estos resultados sugieren que los factores de riesgo cardiovascular evaluados en conjunto favorecen el alto riesgo de desarrollar ateroesclerosis en pacientes co lupus eritematosos sistémico.

Systemic lupus erythematosus is a chronic and multisystemic autoimmune disorder that is associated with early and severe development of atherosclerosis, thus permitting place cardiovascular diseases as the leading cause of morbidity and mortality in patients with this pathology. The present research aimed to evaluate conventional risk factors, unconventional and lupus that contribute to cardiovascular disease development in these individuals. To do this, patients with SLE (n=14 female and male n=1) were performed the following measurements: body mass index (BMI), waist circumference (WC), lipid profile (cholesterol, HDL-c, LDL -C, VLDL-C and triglycerides), uric acid, erythrocyte sedimentation rate (ESR) and fibrinogen. Where found, 85.71% (12/15) and 100% (14/15) of patients were obese, as they showed high values of BMI (38.20±5.30 kg/mm2) and the CA (92.32±7.25 cm), respectively; 100% (15/15) low serum concentrations of HDL-c (26.00±13.03 mg/dL), 93.33% (14/15) exhibited a sedentary lifestyle, 33.33% (5/15) were hypertension patients with hypotensive treatment, 33.33% (5/15) had a family history of cardiovascular disease 6.66% (1/15) elevated VLDL-C, 6.66% (1/15) hypertriglyceridemia. Also found that 20% (3/15) presented hyperfibrinogenemia (434.50±38.90 mg/dL), 26.66% (4/15) hyperuricemia (10.46±2.45 mg/dL) and 100% had values above the reference range for ESR. These results suggest that cardiovascular risk factors evaluated together favor a high risk of developing atherosclerosis with these patients.

Weight Gain in High-Risk Pregnant Women: Comparison by Primary Diagnosis and Type of Care.

Reasonable weight gain in pregnancy is essential for the health of the woman and fetus. The purpose of this secondary analysis was to examine patterns of prenatal weight gain in women with diabetes and hypertension using data from a randomized controlled trial examining physician-only (n = 29) versus APN and physician-delivered (n = 38) prenatal care. Data collection included gestational age at enrollment, delivery, diagnosis (diabetes, hypertension), prepregnancy body mass index (BMI), weight every 4 weeks during pregnancy, and total weight gain during pregnancy. Based on prepregnancy BMI, 21% of the sample was normal weight, 16% overweight, and 63% obese. There were no significant differences between physician versus APN and physician prenatal care and weight gained during pregnancy; the trend in favor of APN and physician care was evident. For women entering pregnancy with a chronic health condition, compounded by obesity, education on nutrition, diet, and behavioral modification is essential.

Síndrome metabólico en individuos del sector "El Valle", municipio Linares Alcántara del Estado Aragua: Período 2007 / Metabolic syndrome in individuals of the sector "El Valle", municipality Linares Alcántara of the State Aragua: Period 2007

Las enfermedades cardiovasculares (ECV), constituyen uno de los principales problema de salud pública en Venezuela, ocupando el segundo lugar como causa de muerte. La hipertensión arterial, el alto consumo de grasas, el sedentarismo y la obesidad, son factores de riesgo importantes en el desarrollo de patologías cardiacas y coronarias. En la actualidad, se han agrupado una serie de factores de riesgo en un cuadro patológico conocido como Síndrome Metabólico (SM), cuya trascendencia radica en que aquellos pacientes que lo padecen presentan un elevado riesgo de sufrir estas enfermedades y diabetes mellitus. La resistencia a la insulina se presenta como base fisiopatológica principal de este síndrome, lo que conlleva al organismo a desencadenar hiperglicemia, hipertrigliceridemia y disminución de la concentración de HDLc, otorgando la gravedad del SM y por ende el desarrollo de ECV. Por tal motivo se efectuó la investigación con el objetivo de determinar la frecuencia de éste síndrome en la población de El Valle, municipio Linares Alcantara, para lo que se seleccionó una muestra aleatoria de 99 individuos de ambos sexos. Para el diagnóstico del síndrome se utilizaron los criterios del Programa Nacional de Educación del Colesterol-Panel del tratamiento de adultos (NCEP-ATPIII). La prevalencia neta de SM fue de 22% de los individuos estudiados, donde la obesidad visceral y la dislipidemia fueron los criterios diagnósticos más resaltantes, encontrando relación significativa p<0.005 con el riesgo cardiovascular. Se concluyó el riesgo cardiovascular en pacientes con SM se incrementa, a medida que aumenta el número de criterios diagnósticos establecidos por el ATP III.

The cardiovascular illnesses (CVI), they constitute one of the main problem of public health in Venezuela, occupying the second place like cause of death. The arterial hypertension, the high consumption of fatty, the sedentarismo and the obesity, they are important factors of risk in the development of heart and coronary pathologies. At the present time, they have grouped a series of factors of risk in a well-known pathological square as Metabolic Syndrome (SM) whose transcendency resides in that those patients that suffer it present a high risk of suffering these illnesses and diabetes mellitus. The resistance to the insulin is presented like base main fisiopatológic of this syndrome, what bears to the organism to unchain hiperglicemy, hipertrigliceridemy and decrease of the concentration of HDLc, granting the graveness of the SM and for the development of ECV. For such a reason you effect the investigation in order to determining the frequency of this syndrome in the population of the Valley, municipality Linares Alcantara, for that that their it selected a random sample of 99 individuals of both sexes. For the diagnosis of the syndrome the approaches of the National Colesterol Education-Adult Treatment Panel (NCEP-ATPIII were used. The prevalence of the SM was of the studied individuals' 22%, where the visceral obesity and the dislipidemy were the approaches diagnostic more significants, finding significant relationship p <0.005 with the cardiovascular risk. You concluded the cardiovascular risk in patient with SM it is increased, as the number of diagnostic approaches settled down by the (NCEPATP III) increases.

Sensibilidad, especificidad, valor predictivo y eficiencia de las tiras reactivas para uroanálisis a los parámetros albumina y glucosa / Sensibility, especificity, predictive value and eficience for urinalsis dipsticks to protein and glucose

Se comparó la sensibilidad, especificidad, valor predictivo y eficiencia de las tiras reactivas marcas: combur, combina, chroma, combi 9, self stick y uriscan a los parámetros albúmina y glucosa. Resultados: para albúmina, la mejor sensibilidad analítica fue de combur y self stick. En muestras biológicas, chroma y uriscan reportaron mejor sensibilidad. La más específica fue combur. El valor predictivo fue para las marcas combur 8 y combina, la mejor eficiencia para combur, chroma y uriscan. Parámetro glucosa: todas las marcas excepto uriscan reaccionaron 100 por ciento positivas al patrón de 40 mg/dl. En muestra biológicas, combur, combina y combi 9 resultaron 100 por ciento sensibles. La más especificas fueron combur 8, chroma, combi 9 y self stick. El valor predictivo positivo fue 100 por ciento para combur y chroma, el valor predictivo negativo fue de 100 por ciento para combur, combina y combi 9. Combur es 100 por ciento eficiente

Sensibilidad, especificidad, valor predictivo y eficiencia de las tiras reactivas para uroanálisis a los parámetros bilirrubina, hemoglobina y urobilinógeno / Sensibility, especifity, predictive value and efficience for urinalisys dipsticks to bilirubin, blood and urobilinogen

Se comparó la sensibilidad, especificidad, valor predictivo y eficiencia de las tiras reactivas marcas: combur, combina, chroma, combi 9, self stick y uriscan a los parámetros hemoglobina, bilirrubina y urobilinógeno. Resultados: hemoglobina: en muestra biológicas combur es 100 por ciento sensible, especifica, valor de predicción y eficiencia. Combi 9 presentó alto porcentaje de falsos positivos. La marca self stick mostró 96,4 por ciento de eficiencia, en función del 100 por ciento de sensibilidad y valor predictivo negativo, y 80 por ciento especificidad. Bilirrubina: combur y self stick reaccionaron 100 por ciento al patrón de 0,4 mg/dL, y 100 por ciento sensibles, especificas, predictivas y eficientes. Las marcas chroma y uriscan mostraron baja eficiencia. Se apreció sobrestimación del valor real de urobilinógeno. Uriscan arrojó 100 por ciento de falsos positivos