Social Determinants of Overweight and Obesity Rates by Elementary School in a Predominantly Hispanic School District.

OBJECTIVE: This study analyzes the social determinants associated with the overweight or obesity prevalence of 85 elementary schools during the 2010-11 academic year in a predominantly Hispanic school district. METHODS: A binomial logistic regression is used to analyze the aggregate overweight or obesity rate of a school by the percent of Hispanic students in each school, selected school and neighborhood characteristics, and its geographical location. RESULTS: The proportion of Hispanic enrollment more readily explains a school's aggregate overweight or obesity rate than social determinants or spatial location. Number of fast food establishments and the academic ranking of a school appear to slightly impact the aggregate prevalence rate. Spatial location of school is not a significant factor, controlling for other determinants. CONCLUSIONS: An elementary school's overall overweight or obesity rate provides a valuable health indicator to study the social determinants of obesity among Hispanics and other students within a local neighborhood.

A Multicenter, Retrospective Outcome Analysis of Vancomycin Area Under the Curve versus Trough-Based Dosing Strategies in Patients with Burn OR Inhalational Injuries (MONITOR).

Vancomycin is a glycopeptide antibiotic that requires close therapeutic monitoring. Prolonged exposure to elevated concentrations increases risk for serious adverse effects such as nephrotoxicity. However, sub-therapeutic concentrations may lead to bacterial resistance and clinical failure or death. The most recent Infectious Diseases Society of America (IDSA) publication regarding therapeutic monitoring of vancomycin recommends utilizing area under the curve (AUC)-based monitoring to maximize clinical success. Despite the guideline recommendation for AUC-guided dosing, many institutions still use trough-only monitoring in their practices, including those caring for patients with acute burn injuries. Following burn injury, patients are at a higher risk for infections, multi-organ failure, and pharmacokinetic alterations. The primary objective of this multi-center retrospective study is to determine optimal therapeutic monitoring of vancomycin by comparing clinical success between AUC vs. trough-based monitoring in burn patients. MONITOR was a multicenter, retrospective study of patients with thermal or inhalation injury admitted to one of 13 burn centers from 1/1/17 to 8/31/22 who received vancomycin. Demographic and clinical course data, including acute kidney injury (AKI) incidence and clinical success were obtained. Patients were evaluated for clinical success and grouped according to method of monitoring and adjusting doses: AUC vs. trough-based monitoring. Clinical success was a composite definition and lack of meeting any 1 of 5 criteria: 1) persistent infection, 2) relapse, 3) antibiotic failure (clinical worsening), 4) AKI, 5) death. Five-hundred seventeen vancomycin courses were assessed from 485 patients. There was no difference in the rate of clinical success between AUC monitored and the trough-only monitored groups. Incidence of AKI was higher in the trough-only group; however, was not statistically significant after controlling for renal function on admission, past medical history of chronic kidney disease (CKD), and concomitant nephrotoxins.

Advancing the business creed? The framing of decisions about public sector managed care.

Relatively little research has clarified how executives of for-profit healthcare organisations frame their own motivations and behaviour, or how government officials frame their interactions with executives. Because managed care has provided an organisational structure for health services in many countries, we focused our study on executives and government officials who were administering public sector managed care services. Emphasising theoretically the economic versus non-economic motivations that guide economic behaviour, we extended a long-term research project on public sector Medicaid managed care (MMC) in the United States. Our method involved in-depth, structured interviews with chief executive officers of managed care organisations, as well as high-ranking officials of state government. Data analysis involved iterative interpretation of interview data. We found that the rate of profit, which proved relatively low in the MMC programme, occupied a limited place in executives' self-described motivations and in state officials' descriptions of corporation-government interactions. Non-economic motivations included a strong orientation toward corporate social responsibility and a creed in which market processes advanced human wellbeing. Such patterns contradict some of the given wisdom about how corporate executives and government officials construct their reality.

Promotoras as mental health practitioners in primary care: a multi-method study of an intervention to address contextual sources of depression.

We assessed the role of promotoras--briefly trained community health workers--in depression care at community health centers. The intervention focused on four contextual sources of depression in underserved, low-income communities: underemployment, inadequate housing, food insecurity, and violence. A multi-method design included quantitative and ethnographic techniques to study predictors of depression and the intervention's impact. After a structured training program, primary care practitioners (PCPs) and promotoras collaboratively followed a clinical algorithm in which PCPs prescribed medications and/or arranged consultations by mental health professionals and promotoras addressed the contextual sources of depression. Based on an intake interview with 464 randomly recruited patients, 120 patients with depression were randomized to enhanced care plus the promotora contextual intervention, or to enhanced care alone. All four contextual problems emerged as strong predictors of depression (chi square, p < .05); logistic regression revealed housing and food insecurity as the most important predictors (odds ratios both 2.40, p < .05). Unexpected challenges arose in the intervention's implementation, involving infrastructure at the health centers, boundaries of the promotoras' roles, and "turf" issues with medical assistants. In the quantitative assessment, the intervention did not lead to statistically significant improvements in depression (odds ratio 4.33, confidence interval overlapping 1). Ethnographic research demonstrated a predominantly positive response to the intervention among stakeholders, including patients, promotoras, PCPs, non-professional staff workers, administrators, and community advisory board members. Due to continuing unmet mental health needs, we favor further assessment of innovative roles for community health workers.

Retraction

The online ahead of print article titled "Assessing Food Safety Practices Among Texas Small Growers" by Zahra H. Mohammad, Isabelle do Prado, Rene Nieto, Richard De Los Santos, and Sujata A. Sirsat has been retracted by the authors and the Scientific Editors. The retraction is necessary because the study and its survey were conducted prior to Institutional Review Board (IRB) approval.

A Rare Case of the Newly Recognized Kaposi Sarcoma Herpesvirus-Associated Disease.

Kaposi sarcoma herpesvirus (KSHV) is associated with Kaposi sarcoma (KS), primary effusion lymphoma, and multicentric Castleman disease (KSHV-MCD) in patients infected with human immunodeficiency virus (HIV). We present a case consistent with a newly recognized KSHV inflammatory cytokine syndrome (KICS), distinct from KSHV-MCD. Although both disorders exhibit signs of substantial inflammation, KICS has minimal lymphadenopathy/splenomegaly and negative pathologic nodal changes in the setting of low CD4 count. KICS is easily misdiagnosed as severe sepsis or other KS-related diseases in HIV/AIDS patients and carries a high mortality. ​Standard therapy is still under investigation due to its rarity, whereas the treatment regimen for KSHV-MCD may lead to clinical remission. Early recognition and prompt management are crucial to improve the survival of the under-recognized KICS.

Determinants of private health insurance coverage among Mexican American men 2010-2013.

BACKGROUND: Private health insurance (PHI) represents the largest source of insurance for Americans. Hispanic Americans have one of the lowest rates of PHI coverage. The largest group in the US Hispanic population are Mexican Americans; they account for about two in every three Hispanics. One in every three Mexican Americans aged 64 years and under did not have health insurance coverage. Mexican Americans have the most unfavorable health insurance coverage of any population group in the nation. OBJECTIVES: The objective is to determine the factors associated with the gap in PHI coverage between Mexican American and non-Hispanic American men. METHODS: This study used the National Health Interview Surveys (2010-2013) as the sample. A non-linear Oaxaca-Blinder decomposition was run, estimating the explained and unexplained gap in PHI coverage between the groups. Several robustness tests of the model were also included. RESULTS: This study estimates that 44.4% of employed Mexican American men are covered by PHI compared to 79.5% of non-Hispanic American men. Nearly 60% of employed Mexican American men were found to be foreign born, 35% have an educational attainment less than a high school degree, and 40% are likely to have language barriers. Decomposition results show that income, low educational attainment, being foreign-born, and language barriers diminished the probability of private health insurance coverage for Mexican Americans, and that 10% of the gap is unexplained. CONCLUSIONS: Most of the difference in the PHI rate between Mexican American men and non-Hispanic men is explained by observable differences in group characteristics: education, language, and immigration status. About 10% of the difference can be attributed to discrimination under the traditional interpretation of an Oaxaca-Blinder decomposition. The PHI rate gap is large and persistent for Mexican American men.

Complete Genome Sequence of Komagataeibacter hansenii Strain HUM-1.

This study reports the release of the complete nucleotide sequence of Komagataeibacter hansenii HUM-1, a new efficient producer of cellulose. Elucidation of the genome may provide more information to aid in understanding the genes necessary for cellulose biosynthesis.

Complete Genome Sequence of Komagataeibacter hansenii LMG 23726T.

This study reports the release of the complete nucleotide sequence of Komagataeibacter hansenii LMG 23726T This organism is a cellulose producer, and its genome may provide more information to aid in the understanding of the genes necessary for cellulose biosynthesis.

Complete Genome Sequence of Komagataeibacter hansenii Strain SC-3B.

This study reports the release of the complete nucleotide sequence of Komagataeibacter hansenii SC-3B, a new efficient producer of cellulose. Elucidation of the genome may provide more information to aid in understanding the genes necessary for cellulose biosynthesis.

Explaining public support (or lack thereof) for extending health coverage to undocumented immigrants.

While the recent passage of health care reform is estimated to provide millions of currently uninsured Americans with access to health coverage, undocumented immigrants are excluded from federal mandates. Since federal reform excludes undocumented immigrants, state governments will largely decide the fate of this vulnerable population. This article investigates public support for including undocumented immigrants in state health care reform efforts in New Mexico. Understanding the public's perception of extending health coverage to this population is important because public opinion influences health policy formation at the state and federal levels. Our results suggest that there is little support for including undocumented immigrants (or recent migrants from other parts of the United States) in state health care reform, particularly when compared with other segments of the New Mexican population, such as the homeless or unemployed. Our discussion highlights the economic and public health consequences of excluding undocumented immigrants from coverage options.