Altered default mode network associated with pesticide exposure in Latinx children from rural farmworker families.

Pesticide exposure has been associated with adverse cognitive and neurological effects. However, neuroimaging studies aimed at examining the impacts of pesticide exposure on brain networks underlying abnormal neurodevelopment in children remain limited. It has been demonstrated that pesticide exposure in children is associated with disrupted brain anatomy in regions that make up the default mode network (DMN), a subnetwork engaged across a diverse set of cognitive processes, particularly higher-order cognitive tasks. This study tested the hypothesis that functional brain network connectivity/topology in Latinx children from rural farmworker families (FW children) would differ from urban Latinx children from non-farmworker families (NFW children). We also tested the hypothesis that probable historic childhood exposure to pesticides among FW children would be associated with network connectivity/topology in a manner that parallels differences between FW and NFW children. We used brain networks from functional magnetic resonance imaging (fMRI) data from 78 children and a mixed-effects regression framework to test our hypotheses. We found that network topology was differently associated with the connection probability between FW and NFW children in the DMN. Our results also indicated that, among 48 FW children, historic reports of exposure to pesticides from prenatal to 96 months old were significantly associated with DMN topology, as hypothesized. Although the cause of the differences in brain networks between FW and NFW children cannot be determined using a cross-sectional study design, the observed associations between network connectivity/topology and historic exposure reports in FW children provide compelling evidence for a contribution of pesticide exposure on altering the DMN network organization in this vulnerable population. Although longitudinal follow-up of the children is necessary to further elucidate the cause and reveal the ultimate neurological implications, these findings raise serious concerns about the potential adverse health consequences from developmental neurotoxicity associated with pesticide exposure in this vulnerable population.

Mental models about heredity among immigrant Latinx adults with limited education from Mexico and Central America.

An understanding of genetics is becoming increasingly relevant to receiving medical care. It is important for health care providers and educators, including genetic counselors, to understand patients' perceptions about trait transmission and their interpretation of terms used in biomedicine. Knowledge about the patient perspective about trait transmission is important when health care providers are not fluent in the patient's language. Sixty Latinx immigrant adults (30 men and 30 women) who were born in Mexico or Central America (MCA) and living in North Carolina were interviewed about their heredity beliefs. By design, most participants had limited education. Eight percent had a least a high school education; 45% had less than a seventh grade education. Semi-structured, in-depth interviews were conducted to examine how participants think and discuss trait transmission. The translated transcripts were systematically analyzed using a case-based approach, supplemented by theme-based coding. Five lay mental models of heredity were identified that varied in terms of involvement of genes. Four of the five heredity mental models encompass genes; four out of five mental models do not link DNA to heredity. The centrality of blood, whether used metaphorically or literally, varies widely across the models. One model references God and depicts that heredity involves blood and/or genes, but not DNA. The mental models of heredity for most adult immigrants with limited education do not include DNA. Trait transmission by blood appears to have a more prominent role in lay mental models held by Mexicans than Central Americans. Increased patient knowledge about genetics can facilitate shared decision-making as genetics becomes increasingly relevant to medical care. Efforts to educate people can be most effective when we first understand the layperson's conceptions or mental models. Health care providers and educators should be aware that MCA adults with limited formal education hold diverse mental models about heredity.

Effect of Diet and Exercise on Knee Pain in Patients With Osteoarthritis and Overweight or Obesity: A Randomized Clinical Trial.

Importance: Some weight loss and exercise programs that have been successful in academic center-based trials have not been evaluated in community settings. Objective: To determine whether adaptation of a diet and exercise intervention to community settings resulted in a statistically significant reduction in pain, compared with an attention control group, at 18-month follow-up. Design, Setting, and Participants: Assessor-blinded randomized clinical trial conducted in community settings in urban and rural counties in North Carolina. Patients were men and women aged 50 years or older with knee osteoarthritis and overweight or obesity (body mass index ≥27). Enrollment (N = 823) occurred between May 2016 and August 2019, with follow-up ending in April 2021. Interventions: Patients were randomly assigned to either a diet and exercise intervention (n = 414) or an attention control (n = 409) group for 18 months. Main Outcomes and Measures: The primary outcome was the between-group difference in the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) knee pain score (range, 0 [none] to 20 [severe]; minimum clinically important difference, 1.6) over 18 months, tested using a repeated-measures mixed linear model with adjustments for covariates. There were 7 secondary outcomes including body weight. Results: Among the 823 randomized patients (mean age, 64.6 years; 637 [77%] women), 658 (80%) completed the trial. At 18-month follow-up, the adjusted mean WOMAC pain score was 5.0 in the diet and exercise group (n = 329) compared with 5.5 in the attention control group (n = 316) (adjusted difference, -0.6; 95% CI, -1.0 to -0.1; P = .02). Of 7 secondary outcomes, 5 were significantly better in the intervention group compared with control. The mean change in unadjusted 18-month body weight for patients with available data was -7.7 kg (8%) in the diet and exercise group (n = 289) and -1.7 kg (2%) in the attention control group (n = 273) (mean difference, -6.0 kg; 95% CI, -7.3 kg to -4.7 kg). There were 169 serious adverse events; none were definitely related to the study. There were 729 adverse events; 32 (4%) were definitely related to the study, including 10 body injuries (9 in diet and exercise; 1 in attention control), 7 muscle strains (6 in diet and exercise; 1 in attention control), and 6 trip/fall events (all 6 in diet and exercise). Conclusions and Relevance: Among patients with knee osteoarthritis and overweight or obesity, diet and exercise compared with an attention control led to a statistically significant but small difference in knee pain over 18 months. The magnitude of the difference in pain between groups is of uncertain clinical importance. Trial Registration: ClinicalTrials.gov Identifier: NCT02577549.

Musculoskeletal injury symptoms among hired Latinx child farmworkers in North Carolina.

BACKGROUND: Although children 10-17 years can be hired to work in agriculture, little research has addressed possible musculoskeletal injuries. Children may be at particular risk for these injuries because of the repetitive and load bearing nature of work tasks. Existing research relies on child workers to self-report musculoskeletal injuries. METHODS: In 2017, 202 Latinx child farmworkers ages 10-17 employed across North Carolina completed survey interviews. In 2018, 145 of these children (94 [64.8%] current farmworkers) completed a physical examination and second interview. The examination obtained findings for upper and lower extremity as well as back injuries. RESULTS: Positive indicators for musculoskeletal symptoms were few in either current or former child farmworkers. The knee was most common site for positive indicators with 15.4% of children having at least one. Combining all anatomical sites, 29.0% of children had at least one positive indicator, with no significant difference between current and former farmworkers. Overall, boys had significantly more indicators of knee injuries than girls (21.3% vs. 4.1%), indicators of ankle injuries were found only in the youngest workers (9.5% of children 11-13 years), and significantly fewer current farmworkers had indicators of lower back injuries than former farmworkers (6.4% vs. 17.7%). CONCLUSIONS: Expectations of injuries come from previous studies using child farmworker self-reports, adult farmworker injury rates, and sports medicine pediatric findings. Hired child farmworkers may not perform activities as repetitious and load-bearing as children in sports training or adult farmworkers. Additional research using physical examination is needed to confirm these findings.

Pesticide exposure among Latinx child farmworkers in North Carolina.

BACKGROUND: Although pesticides have adverse effects on child health and development, little research has examined pesticide exposure among child farmworkers. This analysis addresses two specific aims: (1) describes pesticide exposure among Latinx child farmworkers in North Carolina, and (2) delineates factors associated with this pesticide exposure. METHODS: In 2018 (n = 173) and 2019 (n = 156) Latinx child farmworkers completed interviews and wore silicone wristbands for a single day to measure pesticide exposure. Wristbands were analyzed for 70 pesticides. RESULTS: Most Latinx child farmworkers were exposed to multiple pesticides; the most frequent were pyrethroids (69.9% in 2018, 67.9% in 2019), organochlorines (51.4% in 2018, 55.1% in 2019), and organophosphates (51.4% in 2018, 34.0% in 2019). Children were exposed to a mean of 2.15 pesticide classes in 2018 and 1.91 in 2019, and to a mean of 4.06 pesticides in 2018 and 3.34 in 2019. Younger children (≤15 years) had more detections than older children; children not currently engaged in farm work had more detections than children currently engaged in farm work. Migrant child farmworkers had more detections than nonmigrants. For specific pesticides with at least 20 detections, detections and concentrations were generally greater among children not currently engaged in farm work than children currently engaged. CONCLUSIONS: Children who live in farmworker communities are exposed to a plethora of pesticides. Although further research is needed to document the extent of pesticide exposure and its health consequences, sufficient information is available to inform the policy needed to eliminate this pesticide exposure in agricultural communities.

Work Safety Culture of Latinx Child Farmworkers in North Carolina.

Background: Little research has addressed the safety environment of child farmworkers. This analysis examines the work safety culture experienced by Latinx child farmworkers in North Carolina. Methods: Survey interviews were conducted in 2017 with 202 Latinx children aged 10 to 17 years employed on North Carolina farms. Analysis included measures of the behavioral, situational, and psychological elements of work safety culture. Results: The work culture on North Carolina farms employing Latinx child farmworkers places limited value on safety. Behaviorally, many did not wear appropriate work clothing (e.g., 47.5% wore gloves, 37.1% wore boots). Situationally, few received safety training for tools (40.6%), machinery (24.3%), or pesticides (26.0%); about one-third (33.7%) had worked piece-rate; and many did not have field sanitation services available (e.g., 37.1% had water for washing, 19.8% had soap). Safety attitudes were mixed, and work safety climate was low, with 21.8% stating that their supervisor was only interested in doing the job fast and cheaply. Greater safety training, field sanitation services, and work safety climate were associated with working in western North Carolina, migrant workers, limited English fluency, and working in tomatoes. Wearing appropriate work clothing, not working piece-rate, fewer unsafe work attitudes were associated with working in eastern North Carolina, seasonal worker, speaking English, and working in tobacco. Conclusions: This research makes it apparent that efforts are needed to improve safety culture wherever child farmworkers are employed. Current policy is not providing a safe environment for children working on farms in the United States.

"Be careful!" Perceptions of work-safety culture among hired Latinx child farmworkers in North Carolina.

BACKGROUND: Children as young as 10 years of age can be hired to work on farms. Many of these hired child farmworkers are Latinx. Although these children experience high rates of injury, little research has addressed work-safety perceptions among hired Latinx child farmworkers. METHODS: For this qualitative study, we conducted in-depth interviews in North Carolina in 2016 with 30 Latinx child farmworkers, ages 10 to 17. Our analysis used the work-safety culture conceptual framework to delineate their perceptions of the psychological, behavioral, and situational elements of safety culture. RESULTS: The child farmworkers describe a weak work-safety culture. Psychologically, they understand that their parents want them to be safe, but they observe that safety is important to only a fraction of their supervisors and coworkers. Behaviorally, they recognize many of the hazards they confront while working, but it is not clear how well they use this knowledge to mitigate these hazards or to change their behaviors to avoid these hazards. Situationally, several children note that the only safety training they receive is the imperative to "be careful." Most receive little formal training, much of the training they receive is informally provided by family members and coworkers rather than supervisors, and their training is geared more toward how to complete a task than how to complete the task safely. CONCLUSIONS: Child farmworkers perceive that work-safety culture is of limited importance in agriculture. Regulations are needed that improve work-safety culture in agriculture, especially for those vulnerable due to minority age.

Hired Latinx child farm labor in North Carolina: The demand-support-control model applied to a vulnerable worker population.

BACKGROUND: US government child labor policies allow children as young as age 10 to be hired as workers on farms not operated by family members. Children may face substantial health risks in an industry known for high worker morbidity and mortality rates, due to high demands for productivity, and low control and little support because of the organization of the workplace. This paper examines how child farmworkers in North Carolina experience their work situation. METHODS: In-depth interviews conducted in 2016 with 30 Latinx child farmworkers, ages 10 to 17, were analyzed using concepts from the demand-control-support model. All had worked as either migrant or seasonal hired farmworkers within the past year. RESULTS: Children reported planting, cultivating, and harvesting crops including fruits, vegetables, and tobacco. The crew leader supervisory system, piece-rate pay, and coworker pressure produced significant demands to work quickly and take risks including lifting heavy loads, operating mechanical equipment, and working in excessive heat. Children had little control over work to counter demands they experienced; and they labored in a state of fear of firing, wage theft, and other sanctions. Support was variable, with younger children more likely to experience family and coworker support than older children. CONCLUSIONS: The high demands with limited control and, for some, little support, that these children experience place them at risk and show the possibility of injury and exploitation. Future research should systematically document the occupational injury and illness of hired child farmworkers, and consider whether changes in labor policy are warranted.

Latinx child farmworkers in North Carolina: Study design and participant baseline characteristics.

BACKGROUND: Although children as young as 10 years can work in agriculture, little research has addressed their occupational health. This paper describes a large, multicomponent study of hired Latinx child farmworkers, and the characteristics of children participating in this study. METHODS: Survey interviews were conducted in 2017 with 202 Latinx children aged 10-17 years employed in agriculture across North Carolina (NC). RESULTS: Most (81.2%) participants were born in the United States, 37.6% were female, and 21.3% were aged 10-13 years. Most (95.1%) were currently enrolled in school. Thirty-six (17.8%) were migrant workers. 34.7% had worked in agriculture for 1 year; 18.3% had worked 4+ years. 33.7% worked piece rate. 57.4% worked in tobacco. Participants in western NC differed in personal and occupational characteristics from those in eastern NC. CONCLUSIONS: This study has enrolled a large and diverse child farmworker sample. This overview indicates several important issues for further analysis.

HPV Knowledge and Vaccine Initiation Among Mexican-Born Farmworkers in North Carolina.

The human papilloma virus (HPV) vaccine is an effective but underused cancer prevention tool. This study assessed knowledge of HPV and HPV vaccine initiation among Mexican-born farmworkers in North Carolina. Interviewer-administered questionnaires were conducted with 100 Latino farmworkers and 100 nonfarmworker Latino North Carolina residents in 2015 as part of an ongoing community-based participatory research project. Farmworkers had low levels of knowledge about HPV and the HPV vaccine. They had a similar amount of HPV and HPV vaccine knowledge compared to nonfarmworkers. Farmworkers and nonfarmworkers learned about the HPV vaccine from different sources. Adolescent children of farmworkers and nonfarmworkers had low HPV vaccine initiation. However, for children living in the United States with farmworker parents, vaccine initiation was high. To prevent HPV-related cancers and improve health equity, interventions are needed in order to increase HPV education and vaccine initiation among children of Mexican-born farmworkers and nonfarmworkers. Public health programs should look for partners outside the traditional health care setting to reach underserved populations. Other key strategies include promoting catch-up vaccines, improving patient-provider communication, and providing case management services.

Conventional and complementary cancer treatments: where do conventional and complementary providers seek information about these modalities?

BACKGROUND: Both conventional health care providers and complementary therapists treat cancer patients. To provide effective treatment, both types of providers should to be familiar with their own as well as alternative types of treatment. Our aim was to compare how conventional health care providers (oncology doctors, oncology nurses, family physicians) and complementary therapists (acupuncturists, reflexologists, massage therapists) seek information about conventional and complementary cancer treatments. METHOD: This analysis was conducted on the basis of feedback from 466 participants. We used self-administered questionnaires in a cross-sectional study. RESULTS: The majority of the medical doctors (96%) searched for evidence-based information regarding conventional cancer treatments. They gathered this information mostly from guidelines, which is considered best practice and is expected from Norwegian health personnel. Eighty-one percent of the nurses gather this information from evidence based resources such as UpToDate. Colleagues were asked for information by 58% of the medical doctors and 64% of the nurses. Moreover, 50% of the medical doctors and 57% of the nurses searched for evidence-based information about complementary cancer modalities. The acupuncturists gathered evidence-based information for both conventional (79%) and complementary (77%) modalities, followed by the reflexologists (54 and 54%, respectively) and massage therapists (54 and 52%, respectively). Nearly half of the acupuncturist (49%) asked a colleague for information. CONCLUSION: To provide safe cancer care, it is important that advice about complementary modalities is based on current and evidence-based evaluations. The majority of the medical doctors and nurses in this study sought information according to evidence-based medicine regarding conventional cancer treatments, and about half of them gathered evidence-based information about complementary cancer modalities. This was also true for the complementary therapists as they gathered information about complementary and conventional treatments from evidence-based evaluations. This demonstrates that since the term evidence-based medicine was first introduced in 1991, the approach has grown extensively and both conventional and complementary providers use this approach to seek information.

Insights Into Older Adult Patient Concerns Around the Caregiver Proxy Portal Use: Qualitative Interview Study.

BACKGROUND: Electronic patient portals have become common and offer many potential benefits for patients' self-management of health care. These benefits could be especially important for older adult patients dealing with significant chronic illness, many of whom have caregivers, such as a spouse, adult child, or other family member or friend, who help with health care management. Patient portals commonly contain large amounts of personal information, including diagnoses, health histories, medications, specialist appointments, lab results, and billing and insurance information. Some health care systems provide proxy accounts for caregivers to access a portal on behalf of a patient. It is not well known how much and in what way caregivers are using patient portals on behalf of patients and whether patients see any information disclosure risks associated with such access. OBJECTIVE: The objective of this study was to examine how older adult patients perceive the benefits and risks of proxy patient portal access by their caregivers. METHODS: We conducted semistructured interviews with 10 older adult patients with chronic illness. We asked them about their relationship with their caregivers, their use of their patient portal, their caregiver's use of the portal, and their perceptions about the benefits and risks of their caregiver's use of the portals. We also asked them about their comfort level with caregivers having access to information about a hypothetical diagnosis of a stigmatized condition. Two investigators conducted a thematic analysis of the qualitative data. RESULTS: All patients identified caregivers. Some had given caregivers access to their portals, in all cases by sharing log-in credentials, rather than by setting up an official proxy account. Patients generally saw benefits in their caregivers having access to the information and functions provided by the portal. Patients generally reported that they would be uncomfortable with caregivers learning of stigmatized conditions and also with caregivers (except spouses) accessing financial billing information. CONCLUSIONS: Patients share their electronic patient portal credentials with caregivers to receive the benefits of those caregivers having access to important medical information but are unaware of all the information those caregivers can access. Better portal design could alleviate these unwanted information disclosures.

Attitudes and knowledge about direct and indirect risks among conventional and complementary health care providers in cancer care.

BACKGROUND: Many complementary therapies offer benefits for patients with cancer. Others may be risky for patients due to negative interactions with conventional treatment and adverse effects. Therefore, cancer patients need guidance from health care providers to assess complementary modalities appropriately to receive benefits and avoid harm. METHOD: In a self-administered questionnaire-based cross-sectional study, we compared knowledge and attitudes of health care providers with no training in complementary modalities to that of health care providers with training in complementary modalities about the risks for patients who combine complementary modalities with conventional treatment in cancer care. The analysis was based on responses from 466 participants. RESULTS: The attitudes and knowledge about direct risk followed provider specialty. Ninety-four percent of the medical doctors, 93% of the nurses, and 87% of the providers with dual training, but 70% of the complementary therapists, believed that complementary modalities can cause adverse effects (p < 0.001). The majority of the medical doctors and nurses believed that it is risky to combine complementary and conventional cancer treatments (78% and 93%, respectively), compared to 58% of the providers with dual training and 43% of the complementary therapists (p < 0.001). Eighty-nine percent of the medical doctors and nurses believed that complementary modalities should be subjected to more scientific testing before being accepted by conventional health care providers, in contrast to 56% of the dually trained and 57% of the complementary therapists (p < 0.001). The majority of the medical doctors (61%) and nurses (55%) would have neither discouraged nor encouraged the use of complementary modalities if patients asked them for advice. Moreover, less than 1% of the complementary therapists would have discouraged the use of conventional cancer treatments. The study participants believed that the most important factor to recommend a complementary cancer modality to patients is evidence for safety. CONCLUSION: The health care providers in this study believed that complementary modalities are associated with direct risk and can cause adverse effects, and that it is risky to combine conventional and complementary treatments due to potential harmful interactions.

Relationship between maternal depression symptoms and child weight outcomes in Latino farmworker families.

This study sought to characterize depressive symptoms among mothers in Latino farmworker families, determine if maternal depression increases children's risk of obesity, and ascertain whether relevant risk factors such as physical activity, diet, and feeding style mediate this relationship. Mothers from 248 families completed the 10-item Center for Epidemiologic Studies Depression Scale 9 times over a 2-year period. Four distinct patterns were used to describe mothers: few symptoms, moderate episodic symptoms, severe episodic symptoms, and chronic symptoms. Approximately two-thirds of women experienced moderate symptoms of depression at least once. Children of mothers fitting each pattern were compared. At the end of the study, children of mothers with severe episodic and chronic symptoms were significantly more likely to be overweight and obese than children of mothers with few symptoms (p < .05). After controlling for covariates, differences in weight status for children of mothers with severe episodic symptoms remained significant. Children of mothers with either moderate episodic or chronic symptoms were fed in a less responsive fashion (p < .05), and children of chronically symptomatic mothers had lower diet quality (p < .01). Although nonresponsive feeding has been linked to childhood obesity, in this analysis, feeding style did not mediate the relationship between maternal depression and diet quality. Elevated levels of depressive symptoms are common in this population, and those symptoms, especially when severe or chronic in nature, may increase children's risk of obesity. Additional research is needed to characterize the pathways through which maternal depression influences children's weight.

Determinants of Adiposity Rebound Timing in Children.

OBJECTIVE: Adiposity rebound (AR) or BMI (body mass index) rebound refers to the increase in BMI following the minimum BMI in early childhood. Early AR (before age 5) is predictive of adult obesity. To determine how 4 domains - demographics, maternal BMI, food security, and behavioral characteristics - may affect timing of AR. STUDY DESIGN: A total of 248 children, ages 2.5-3.5 years, in Latino farmworker families in North Carolina were examined at baseline and every 3 months for 2 years. BMI was plotted serially for each child and the onset of BMI rebound was determined by visual inspection of the graphs. Given the ages of the children, all rebounds were detected before age 5 years and were deemed "early," whereas other children were classified as "nonrebounders." Classes were then compared in terms of the 4 domains with the use of bivariate analyses and linear mixed models. RESULTS: A total of 131 children demonstrated early rebound, 59 children were nonrebounders, and a further 35 had inconclusive data. Parents of early rebounders were less likely to have documentation permitting legal residence in the US. Mothers of early rebounders were on average 3 BMI units heavier. Sex, household food security, diet quality, caloric intake, and daily activity did not differ between classes. In multivariable analysis, female sex, limited maternal education, increased maternal BMI, and increased caloric intake were significant predictors of early rebound. CONCLUSION: High maternal BMI was the strongest predictor of early BMI rebound, but increased caloric intake also was significant. Limiting excess calories could delay premature AR and lower the risk of future obesity.

Weight-loss and exercise for communities with arthritis in North Carolina (we-can): design and rationale of a pragmatic, assessor-blinded, randomized controlled trial.

BACKGROUND: Recently, we determined that in a rigorously monitored environment an intensive diet-induced weight loss of 10% combined with exercise was significantly more effective at reducing pain in men and women with symptomatic knee osteoarthritis (OA) than either intervention alone. Compared to previous long-term weight loss and exercise trials of knee OA, our intensive diet-induced weight loss and exercise intervention was twice as effective at reducing pain intensity. Whether these results can be generalized to less intensively monitored cohorts is unknown. Thus, the policy relevant and clinically important question is: Can we adapt this successful solution to a pervasive public health problem in real-world clinical and community settings? This study aims to develop a systematic, practical, cost-effective diet-induced weight loss and exercise intervention implemented in community settings and to determine its effectiveness in reducing pain and improving other clinical outcomes in persons with knee OA. METHODS/DESIGN: This is a Phase III, pragmatic, assessor-blinded, randomized controlled trial. Participants will include 820 ambulatory, community-dwelling, overweight and obese (BMI ≥ 27 kg/m2) men and women aged ≥ 50 years who meet the American College of Rheumatology clinical criteria for knee OA. The primary aim is to determine whether a community-based 18-month diet-induced weight loss and exercise intervention based on social cognitive theory and implemented in three North Carolina counties with diverse residential (from urban to rural) and socioeconomic composition significantly decreases knee pain in overweight and obese adults with knee OA relative to a nutrition and health attention control group. Secondary aims will determine whether this intervention improves self-reported function, health-related quality of life, mobility, and is cost-effective. DISCUSSION: Many physicians who treat people with knee OA have no practical means to implement weight loss and exercise treatments as recommended by numerous OA treatment guidelines. This study will establish the effectiveness of a community program that will serve as a blueprint and exemplar for clinicians and public health officials in urban and rural communities to implement a diet-induced weight loss and exercise program designed to reduce knee pain and improve other clinical outcomes in overweight and obese adults with knee OA. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT02577549 October 12, 2015.

Complementary and conventional providers in cancer care: experience of communication with patients and steps to improve communication with other providers.

BACKGROUND: Effective interdisciplinary communication is important to achieve better quality in health care. The aims of this study were to compare conventional and complementary providers' experience of communication about complementary therapies and conventional medicine with their cancer patients, and to investigate how they experience interdisciplinary communication and cooperation. METHOD: This study analyzed data from a self-administrated questionnaire. A total of 606 different health care providers, from four counties in Norway, completed the questionnaire. The survey was developed to describe aspects of the communication pattern among oncology doctors, nurses, family physicians and complementary therapists (acupuncturists, massage therapists and reflexologists/zone-therapists). Between-group differences were analyzed using chi-square, ANOVA and Fisher's exact tests. Significance level was defined as p < 0.05 without adjustment for multiple comparisons. RESULT: Conventional providers and complementary therapists had different patterns of communication with their cancer patients regarding complementary therapies. While complementary therapists advised their patients to apply both complementary and conventional modalities, medical doctors were less supportive of their patients' use of complementary therapies. Of conventional providers, nurses expressed more positive attitudes toward complementary therapies. Opportunities to improve communication between conventional and complementary providers were most strongly supported by complementary providers and nurses; medical doctors were less supportive of such attempts. A number of doctors showed lack of respect for complementary therapists, but asked for more research, guidelines for complementary modalities and training in conventional medicine for complementary therapists. CONCLUSION: For better quality of care, greater communication about complementary therapy use is needed between cancer patients and their conventional and complementary providers. In addition, more communication between conventional and complementary providers is needed. Nurses may have a crucial role in facilitating communication, as they are positive toward complementary therapies and they have more direct communication with patients about their treatment preferences.

"Aguantamos": Limits to Latino Migrant Farmworker Agency in North Carolina Labor Camps.

Each year, tens of thousands of Latino migrant farmworkers return to the hills and fields of North Carolina to live in employer-provided labor camps that often fail to meet regulatory and ethical standards. Little attention has been paid to how these workers and their families perceive and respond to substandard housing conditions. This paper analyzes how far and in what ways Latino migrant farmworkers living in eastern North Carolina labor camps feel their agency extends in responding to substandard housing and work conditions, while also considering who among them has the power to exercise this agency. Based on qualitative analysis of interviews with twenty-three migrant farmworkers or partners of farmworkers, our findings indicate that the limits of migrant farmworker agency are strongly dictated by the close relationship between migrant farmworker employment and housing; by the importance of remittance wages for dependents; and by individual immigration, gender, and education characteristics. In the current context, the informal and reparative nature of agentive acts in substandard labor camps creates real but minor improvements while also co-constructing the very structural neglect to which it responds. We conclude that current housing and labor policy frameworks do little to amplify and support differentially distributed migrant farmworker agency and its individualized successes.

Examining the association between musculoskeletal injuries and carpal tunnel syndrome in manual laborers.

INTRODUCTION: The association between musculoskeletal injuries and carpal tunnel syndrome (CTS) has not been investigated in a large, population-based study. METHODS: Latino manual laborers were recruited as part of a study of work-related health conditions. Each had a clinical examination, completed a hand diagram, and had nerve conduction studies. RESULTS: A total of 512 individuals completed all testing. An association was found between rotator cuff syndrome and CTS, with an adjusted odds ratio of 2.25 (P = 0.01) for the right arm, 2.08 (P = 0.03) for the left arm, and 1.84 (P = 0.03) for all individuals. Associations between epicondylitis and CTS did not reach statistical significance. CONCLUSIONS: Individuals with rotator cuff syndrome have a higher prevalence of CTS. Further investigations will be needed to examine for causation and to determine if 1 condition typically occurs first and leads to the other. Muscle Nerve 54: 31-35, 2016.