How providing a low-cost water filter pitcher led Latino parents to reduce sugar-sweetened beverages and increase their water intake: explanatory qualitative results from the Water Up!@Home intervention trial.

OBJECTIVE: This study sought to explain results of the Water Up!@Home randomised controlled trial where low-income parents were randomised to receive an educational intervention +a low-cost water filter pitcher or only the filter. Parents in both groups had reported statistically significant reductions in sugar-sweetened beverages (SSB) and increases in water intake post-intervention. DESIGN: Qualitative explanatory in-depth interviews analysed thematically and deductively. SETTING: Washington, DC metropolitan area, USA. PARTICIPANTS: Low-income Latino parents of infants/toddlers who had participated in the Water Up! @Home randomised controlled trial. RESULTS: The filter-stimulated water consumption in both groups by (1) increasing parents' perception of water safety; (2) acting as a cue to action to drink water; (3) improving the flavour of water (which was linked to perceptions of safety) and (4) increasing the perception that this option was more economical than purchasing bottled water. Safe and palatable drinking water was more accessible and freely available in their homes; participants felt they did not need to ration their water consumption as before. Only intervention participants were able to describe a reduction in SSB intake and described strategies, skills and knowledge gained to reduce SSB intake. Among the comparison group, there was no thematic consensus about changes in SSB or any strategies or skills to reduce SSB intake. CONCLUSIONS: A low-cost water filter facilitated water consumption, which actively (or passively for comparison group) displaced SSB consumption. The findings have implications for understanding and addressing the role of water security on SSB consumption.

How Latina mothers navigate a 'food swamp' to feed their children: a photovoice approach.

OBJECTIVE: To understand how mothers who recently migrated from Central America to the USA feed their children in a neighbourhood saturated with unhealthful food choices ('food swamp') and to formulate a mother-driven plan of action to facilitate their acquisition of foods. Design/Setting/Subjects We purposively sampled mothers with children (<10 years old) who were recent immigrants/refugees from Central America and lived in a 'food swamp' neighbourhood. We used the photovoice approach to elicit textual data from thirty in-depth interviews, a participatory workshop, and visual data from photographs. Analyses were guided by the Social Ecological Framework and Social Cognitive Theory to identify barriers, facilitators and strategies that support parents in feeding their children. RESULTS: Mothers valued foods that they considered to be 'traditional' and 'healthful'. They navigated their food retail environment looking for these foods (of good quality and well-priced). Food values were reinforced by pre-migration food customs and culture, health professionals' advice and, in some cases, by the desire to avoid conflict with their children. The neighbourhood food environment could directly influence children's food preferences and often created conflict between what the child wanted to eat and the foods that mothers valued. Mothers in this 'food swamp' wanted to be engaged in addressing the selection of foods offered in schools and in neighbourhood food venues to reflect their own food values. CONCLUSIONS: These mothers' feeding choices were influenced directly by their food values, and indirectly by the neighbourhood and school food environments via their children's preferences.

Formative Research to Design a Promotional Campaign to Increase Drinking Water among Central American Latino Youth in an Urban Area.

Latinos consume more sugary drinks and less water than other demographic groups. Our objective was to understand beverage choice motivations and test promotional concepts that can encourage Central American Latino urban youth to drink more water. Two rounds of focus group discussions were conducted (n = 10 focus groups, 61 participants, 6-18 years old). Data were transcribed verbatim and analyzed using inductive and deductive coding approaches. Youth motivations for drinking water were shaped by level of thirst, weather, energy, and perceptions of health benefits. Youth were discouraged from drinking water due to its taste and perceptions of the safety and cleanliness of tap water. Youth beverage preference depended on what their friends were drinking. Availability of water versus other beverages at home and other settings influenced their choice. Promotional materials that included mixed language, informative messages about the benefits of drinking water, and celebrities or athletes who were active, energized, and drinking water were preferred. A promotional campaign to increase water consumption among these Latino youth should include bicultural messages to underscore the power of water to quench true thirst, highlight the health benefits of drinking water, and address the safety of tap water.

Shared Perceptions on Upstream Factors that Influence Water and Sugar-Sweetened Beverage Consumption Among Hispanic Families in the Greater Washington, DC, Metro Area: Qualitative Results From Focus Group Discussions.

BACKGROUND: Hispanics in the United States are among those with highest consumption of sugar-sweetened beverages (SSBs) and lowest consumption of water. These dietary disparities are rooted in systemic influences that must be identified and addressed. OBJECTIVE: The study aimed to describe how Hispanic parents currently living in the greater Washington, DC, metro area and born outside of the United States, perceived upstream factors that influenced their current beverage choice. DESIGN: Six qualitative focus groups were conducted in Spanish in 2021. PARTICIPANTS/SETTING: Hispanic parents (n = 31) of children enrolled in Early Head Start in the greater Washington, DC, metro area were recruited (all women, born outside the United States, and spoke Spanish as a first language). STATISTICAL ANALYSIS: Verbatim transcripts were analyzed deductively using the Community Energy Balance Framework. RESULTS: The five key findings were: Growing up (in their countries of origin in Central America and Mexico) participants were used to drinking water, often gathered it from the source, and liked its flavor. Relatives passed down their knowledge about potabilization of water, the health benefits of drinking water, and health consequences of drinking SSBs. Growing up, prepackaged SSBs were not as accessible compared with where they now live in the United States. Participants perceived that sociocultural hospitality norms dictated that guests should be served SSBs and not water. Participants noted that messages regarding juice and water across US public health programs and policies were not aligned. CONCLUSIONS: These findings suggest there are opportunities for public health messaging and procurement of safe, palatable drinking water in lieu of SSBs and juice.

Use of a Water Filter at Home Reduces Sugary Drink Consumption among Parents and Infants/Toddlers in a Predominantly Hispanic Community: Results from the Water Up!@ Home Intervention Trial.

BACKGROUND: Water is recommended as an alternative for sugar-sweetened beverages (SSBs). Low-income, minority groups in the United States continue to exhibit high SSB and low water consumption, and are more likely to exceed 100% fruit juice recommendations. OBJECTIVE: To test the effects of a home-based intervention designed to replace SSBs with tap water and reduce excess juice consumption among parents and their infants/toddlers. DESIGN: Randomized controlled trial. PARTICIPANTS: Parents (n = 92) of infants/toddlers who participated in three Early Head Start home-visiting programs that serve predominantly Hispanic, low-income communities during 2019-2021. INTERVENTION: The 12-week intervention (Water Up!@Home) simultaneously addressed physical barriers to tap water consumption (via a water filter) and sociocultural barriers to replacing SSBs and juice with water (via a curriculum). Comparison group received a water filter only. We hypothesized that the intervention would lead to a reduction of 6 fl oz/d in SSB and juice consumption. MAIN OUTCOMES: Parent-reported self and infant/toddler SSBs, water (filtered, tap, or bottled), and 100% fruit juice consumption. STATISTICAL ANALYSES: Analysis of covariance to compare changes in consumption between experimental groups was performed. We also conducted t tests to assess changes within groups. RESULTS: Participants in both groups reported significant reductions in SSBs from baseline (parents: intervention [-11.2 fl oz/d; P < 0.01]; comparison [-8.0 fl oz/d; P < 0.01]; children: intervention [-1.50 fl oz/d; P = 0.03]; comparison [-1.56 fl oz/d; P = 0.02]), increased water consumption (parents in both groups [+5.6 fl oz/d]; children: intervention [+3.61 fl oz/d; P = 0.01], comparison [+2.24 fl oz/d; P = 0.05]), mostly from filtered tap water. Differences between groups were not statistically significant. Intervention participants reported significant reductions in 100% fruit juice vs comparison (parents: -3.6 fl oz/d vs -1.0 fl oz/d; P < 0.01; children: -0.73 fl oz/d vs +0.48 fl oz/d; P = .03). CONCLUSIONS: The intervention effectively reduced 100% fruit juice consumption. Water security should be examined as a contributor to SSB consumption in this population.

Barriers and facilitators to smoking cessation among Latino adults.

BACKGROUND: Previous studies have found that Latinos who smoke are less likely than non-Latino white smokers to use pharmaceutical aids such as nicotine replacement therapies or to receive physician advice to stop smoking. This qualitative study further explored barriers and facilitators to smoking cessation among Latino adults in Maryland. METHODS: Five Spanish-language focus groups were conducted in September 2008 in Maryland with Latino current smoker and ex-smoker men and women (n = 55). Participants were recruited through flyers, information sheets, and site visits at community health clinics and Latino events, and were predominately of Central American origin. RESULTS: Personal health concerns were the main reason to quit smoking; impact on children and family health and role model pressure were frequently mentioned. Barriers to quit smoking included environmental temptation and social factors, emotional pressure, addiction, and habitual behavior. Respondents mostly relied on themselves for cessation, with little use of cessation products or other medications, or awareness of available services. CONCLUSIONS: Social influence serves both as a strong motivation for Latinos to quit smoking and as a source of temptation to continue smoking. Favored by both current smokers and ex-smokers, lay health promoters are effective agents to reach Latinos with smoking cessation interventions. In addition, the low use of cessation services could be improved by increasing awareness and availability of Spanish-language cessation services.

Transnational determinants of health for Central American migrants to the U.S.: Results of a qualitative study.

While some research on health determinants for immigrant/refugee populations has considered migration itself as a health determinant, much of this research employs constructs that focus on factors such as language, acculturation, norms, behaviours, beliefs, and social support, in a manner analogous to health risk factors for domestic U.S. populations. These are, however, often disassociated from the broader context of migration and its transnational continuum. As a contribution towards addressing that gap, this study reports on 75 life history interviews from recent Central American immigrants to assess potential health determinants in three linked domains - home country situation, migration experience, and adjustment to the U.S. These domains were conceptualised as one transnational continuum, with health outcomes potentially resulting from combined effects across domains. Interview data showed, among other results, extensive experience with/victimisation from violence in the home countries and during migration, resulting in multiple health outcomes (including PTSD) in the U.S. It also showed some patterns of resiliency, as well as added stressors from the current political environment. The results and protocol from this pilot study are useful for broader research efforts in multiple global settings, and as narratives, should also help counter negative public representations and support improved treatment.

Feasibility of collaborating with independent Latino-owned restaurants to increase sales of a healthy combo meal.

Americans spend the majority of their food dollars at restaurants and other prepared food sources, including quick-service and fast-food restaurants (PFS); independent small restaurants make up 66% of all PFS in the US. In this feasibility study, 5 independent and Latino-owned PFS in the Washington DC metro area worked with academic partners to start offering healthy combo meals with bottled water and promote these using on-site, community, and social media advertising. The number of healthy combos sold was collected weekly, showing that the new combos sold, and customers in all 5 sites were surveyed as they exited the PFS (n=50): >85% had noticed the combo meals; 100% thought it was a good idea to offer it, 68% had ordered the combo (of these, >94% of customers responded that they liked it).  Results suggest that it is feasible to work with independent Latino-owned restaurants to promote healthy combos and collect data.

The SAFER Latinos project: Addressing a community ecology underlying Latino youth violence.

This paper describes the intervention model, early implementation experience, and challenges for the Seguridad, Apoyo, Familia, Educacion, y Recursos (SAFER) Latinos project. The SAFER Latinos project is an attempt to build the evidence for a multilevel participatory youth violence prevention model tailored to the specific circumstances of Central American immigrants. Specific circumstances targeted in this intervention are decreased family cohesion as a result of sequential immigration (i.e., parents arriving first and bringing their children years later or youth arriving without parents); multiple school barriers; community disorganization and low community efficacy; limited access to services; and a social context (including gang presence) that is linked to youth norms supporting violence. In its implementation, the initial intervention model was adapted to address barriers and challenges. These are described, along with lessons learned and the ongoing evaluation.

Treatment Failure with Direct Antiviral Agents in Patients with Hepatitis C Virus Genotype 1 Infection at the Veteran Affairs Caribbean Healthcare System in San Juan, Puerto Rico.

OBJECTIVE: We performed a descriptive study of patients who have failed to DDAs in our Veteran population. The primary outcome of this study is to describe the clinical profile of these patients and to evaluate their respective resistance mutation panel. METHODS: This investigation is a descriptive retrospective study of patients with chronic hepatitis C between the ages of 21 to 89 years from the Veteran Affairs Caribbean Healthcare System in P.R. Eligible cases were Veterans treated for hepatitis C with second generation of DAAs from January 1, 2015 to December 31, 2016 who failed to therapy. Patient records were reviewed and those who met inclusion criteria were included. RESULTS: Among Hispanic Veterans treated with DAA for genotype 1 HCV infection, 3.9% had failure to treatment with the second generation DAAs. 90% were genotype 1a; while 10% were 1b. 80% of these were identified as cirrhotic and the other 20% were non cirrhotic. 90% had resistant variants for Ns5a. Eight patients had Ns3 RASs testing requested of which 50% had presence of resistant variants. Five patients had Ns5b RASs testing performed of which 40% had positivity for resistant variants to Ns5b. CONCLUSION: Despite DAA effectiveness, phase III clinical trials with new IFN-free DAA-based therapies have a 5-7% treatment failure rates. Real-life data has showed that <15% of patients fail to achieve SVR in the most difficult to cure groups such as those with cirrhosis or subtype 1a. These findings are comparable with our current study.

Immigrant Trauma and Mental Health Outcomes Among Latino Youth.

While research has demonstrated an association between trauma and mental health, this study examined the association between trauma experienced premigration, during migration, and postmigration, and current mental health status among Latino youth aged 12-17 years old living in the US for < 3 years. Participants reported traumatic events experienced in their home country, during migration, and after settling in the US. Regression models examined trauma experienced at each stage of the migration process predicting current levels of depression, anxiety, and post-traumatic stress disorder. Two-thirds of youth experienced at least one traumatic event, 44% experienced an event once, and 23% experienced two or more traumatic events during migration. Trauma experienced at different migration stages was associated with distinctive mental health outcomes. It is essential that access to culturally sensitive assessment and treatment services be available to ensure transition to a healthy adulthood.

Eosinophilic Liver Infiltration.

Eosinophilic liver infiltration is a commonly encountered focal eosinophil-related inflammation with or without necrosis, which can be seen on computed tomography (CT) in the presence of peripheral eosinophilia. Although this entity has a relatively benign course, it is related to numerable conditions for which diagnosis may be challenging and requires substantial diagnostic work-up for proper management and care of the underlying disease. We report a case of a 60-year-old man who presented with a 1-week history of right upper quadrant abdominal pain with multiple ill-defined liver hypodensities associated with significant eosinophilia.

Cannabinoid Hyperemesis Syndrome: A Paradoxical Cannabis Effect.

Despite well-established antiemetic properties of marijuana, there has been increasing evidence of a paradoxical effect in the gastrointestinal tract and central nervous system, given rise to a new and underrecognized clinical entity called the Cannabinoid Hyperemesis Syndrome. Reported cases in the medical literature have established a series of patients exhibiting a classical triad of symptoms: cyclic vomiting, chronic marijuana use, and compulsive bathing. We present a case of a 29-year-old man whose clinical presentation strongly correlates with cannabinoid hyperemesis syndrome. Despite a diagnosis of exclusion, this syndrome should be considered plausible in the setting of a patient with recurrent intractable vomiting and a strong history of cannabis use as presented in this case.

Priorities of low-income urban residents for interventions to address the socio-economic determinants of health.

OBJECTIVES: To determine the priorities of low-income urban residents for interventions that address the socio-economic determinants of health. METHODS: We selected and estimated the cost of 16 interventions related to education, housing, nutrition, employment, health care, healthy behavior, neighborhood improvement, and transportation. Low-income residents of Washington, D.C. (N=431) participated in decision exercises to prioritize these interventions. RESULTS: Given a budget valued at approximately twice an estimated cost of medical and dental care ($885), the interventions ultimately prioritized by the greatest percentage of individuals were: health insurance (95%), housing vouchers (82%) dental care (82%), job training (72%), adult education (63%), counseling (68%), healthy behavior incentives (68%), and job placement (67%). The percentages of respondents who received support for housing, adult education, and job training and placement were far less than the percentage who prioritized these interventions. CONCLUSIONS: Poor and low-income residents' priorities may usefully inform allocation of social services that affect health.

Cortical DNA methylation maintains remote memory.

A behavioral memory's lifetime represents multiple molecular lifetimes, suggesting the necessity for a self-perpetuating signal. One candidate is DNA methylation, a transcriptional repression mechanism that maintains cellular memory throughout development. We found that persistent, gene-specific cortical hypermethylation was induced in rats by a single, hippocampus-dependent associative learning experience and pharmacologic inhibition of methylation 1 month after learning disrupted remote memory. We propose that the adult brain utilizes DNA methylation to preserve long-lasting memories.

­Quiénes fuman en un hospital general? Comentario clínico / Who smokes in a General Hospital? Clinical

Justificación y objetivo. El consumo de tabaco es un problema de salud pública. En los hospitales existe un grupo de trabajadores que fuman, debe investigarse quiénes son fumadores activos.Método. Se realizó una encuesta con preguntas cerradas a 659 trabajadores de un hospital general de tercer nivel para conocer la prevalencia del consumo de tabaco. Resultados. El hábito de fumar fue positivo en 184 personas y negativo en 475. La mayoría de los fumadores estaban casados y pertenecían a las áreas administrativa (53) y médica (46). El grado de escolaridad no fue un factor determinante para el consumo de tabaco. La edad de inicio más frecuente fue entre los 10 y 20 años. Las principales causas para el consumo de tabaco son la sensación de placer, la relajación y la necesidad de fumar. Conclusión. El principal lugar de consumo de tabaco es el área laboral, lo que ocasiona que 72 por ciento de la población encuestada que convive con los fumadores activos sea de fumadores pasivos. Por lo que se considera la importancia de tomar acciones para evitar el tabaquismo en áreas de trabajo y tener un hospital libre de humo de tabaco.