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Percutaneous Closing of an Cribriform Secundum Atrial Septal Problem as well as Evident Foramen Ovale.
Purpose Although psychological distress is common among Latinos in the United States, they underutilize mental health services. We describe a community-based program to manage stress and reduce depressive symptoms among low-income Spanish-speaking Latinos. Methods Mentes Positivas en Acción (MPA) (Positive Minds in Action) is an 8-week group program, delivered by trained promotores in community settings and evaluated through a randomized feasibility study. Participants were randomly assigned to an immediate MPA treatment group or a delayed-intervention control group. Outcomes assessed at baseline and 8 weeks included stress (Perceived Stress Scale [PSS]) and depressive symptoms (PHQ-9); higher scores indicate worse health. Repeated-measures analysis of variance examined group×time interaction effects for group differences in change from baseline to 8 weeks. The control group offered the program after the 8-week assessment, completed an additional assessment at the end of the program (16 weeks); t-tests assessed within-group changes. Results Most participants were female, born in Mexico, and spoke only Spanish. Group×time interaction effects were significant for both outcomes. Mean PSS scores improved in the treatment group but not the control group (-0.80 vs. +0.10; p less then 0.014). Mean PHQ-9 scores improved more in the treatment group than the control group (-5.7 vs. -0.3; p less then 0.011). Within-group analyses of the control group found significant improvements in stress (-0.8; p less then 0.000) and depressive symptoms (-3.9; p less then 0.002). Conclusions This study provides preliminary evidence of the effectiveness of a community-based promotor-delivered program to manage stress and reduce depressive symptoms among vulnerable underserved Latinos in the United States.Purpose In an effort to transition toward universal health coverage (UHC), Jamaica abolished user fees at all public health facilities in 2008. We aimed to determine the extent of out-of-pocket payments (OPPs) and the other cost barriers to UHC among patients with sickle cell disease (SCD). Methods Patients presenting to the Sickle Cell Unit in Kingston, Jamaica, for routine care between October 2019 and August 2020 were consecutively recruited and interviewed about their latest hospitalization within the previous 4 weeks. Parents or guardians completed the questionnaire on behalf of pediatric patients. The questionnaire included the Patient Satisfaction Questionnaire Short Form (PSQ)-18 and the health module of the Jamaica Survey of Living Conditions. Results There were 103 patients with ages ranging from 7 months to 56 years (51.5% female, 60.2% public hospitalizations, and 54.4% pediatric). The modal income (J$6200-$11,999 per week) was similar to the minimum wage and 48.5% lived in overcrowded households. Government drug-subsidy cards were owned by 39.8%. OPPs were made by 19.4% of persons for items and tests that were unavailable at public facilities. There were no costs reported by 69.6%, who visited public pharmacies. Similarly, the cost of admission to public hospitals was free for 95.4% of subjects. Using public transportation, private hospitalization, and having more disease complications were predictive of a perception that health care is unaffordable. Conclusion Most SCD subjects reported no expense with public hospitalizations; however, approximately one in five reported OPPs. Efforts are needed to increase the availability of subsidized items, and the use of drug-subsidy cards, to improve UHC.Purpose This perspective piece reflects off previously published qualitative work to explore (1) themes surrounding equitable prenatal care in Appalachia and (2) strategies to restructure care delivery in a population with disparate rates of preterm birth (PTB). Methods This study reflects in-depth interviews with 22 Appalachian women who experienced PTB and 14 obstetric providers. Results Our findings underscore the need for greater cultural humility in prenatal care, heightened awareness of social determinants of health, and strategic planning to establish equity in birth outcomes. Conclusion Prenatal care must undergo a paradigm shift to include a comprehensive discussion of cultural humility, social disparities, and health equity.Purpose Dietary behaviors are key modifiable risk factors in averting cardiovascular disease (CVD), the leading cause of morbidity, mortality, and disability in the United States. Before investing in adoption and implementation, community-based organizations, public health practitioners, and policymakers-often working with limited resources-need to compare the population health impacts of different food policies and programs to determine priorities, build capacity, and maximize resources. Numerous reports, reviews, and policy briefs have synthesized across evidence-based policies and programs to make recommendations, but few have made a deep acknowledgment that dietary policies and programs are not implemented in a vacuum, and that "real-world" settings are complex, multifaceted and dynamic. Methods A narrative review was conducted of currently recommended evidence-based approaches to improving dietary behaviors, to describe and characterize applied and practical factors for consideration when adopting and implementing these dietary policies and programs across diverse settings. Results From the narrative review, six key considerations emerged to guide community-based organizations, public health practitioners, and policymakers on moving from the evidence base, toward implementation in local and community settings. Conclusions Considerations of "real-world" contextual factors are necessary and important when adopting and selecting evidence-based policies and programs to improve dietary behaviors and ultimately improve CVD outcomes. Promising approaches include those that apply community-partnered research and systems science to examine the equitable implementation of evidence-based dietary policies and programs.Purpose This pilot study used data from a survey to examine the knowledge, attitudes, and practices about oral care of Latinx parents/caregivers of children with or without autism spectrum disorder (ASD) to identify gaps to focus future intervention. Methods Sixty English-speaking Latinx parents/caregivers who had a child between 4 and 14 years with or without ASD (n=31 ASD, n=29 typically developing [TD]) completed a questionnaire on oral health knowledge, practices, access to care, and demographics. Caregiver responses were compared, and gaps in knowledge and practices were identified. K-Ras(G12C) inhibitor 12 price Results There were no significant differences in parent age, child age, income, insured status, or overall knowledge scores, only a significant difference in education (p=0.02), with the ASD group reporting less. Scores for knowledge, attitudes, access and practice were all nonsignificantly positively correlated, as was attitudes with access and practice. However, knowledge and attitudes were significantly negatively correlatinequities.Purpose Occupational exposure to patients with COVID-19 is a stress factor. The aim of this study was to assess gender differences in anger among medical hospital staff. Methods N=78 hospital employees with direct or indirect contact to patients with COVID-19 completed State-Trait Inventory-2. Results Female personnel showed higher scores in the main "trait anger" scale and its subscale "anger temperament," whereas "anger control-out" was significant lower. Direct patient contact had no influence. Conclusion More specific training for female hospital staff could achieve health-related equity. Focusing on anger as a leading indicator could lead to better prevention and self-monitoring. Registered at Clinicaltrials.gov (NCT04368312).Purpose The coronavirus disease 2019 (COVID-19) pandemic presents health care challenges to asylum seekers living in congregate encampments, including those along the U.S.-Mexico border. It is necessary to understand the impact of the pandemic among this population to address health care needs, reduce transmission, and diminish COVID-19-related morbidity. Methods Thirty interviews were conducted with asylum seekers and health care professionals in a temporary camp in Matamoros, Mexico to determine challenges, perceptions, and effects of the COVID-19 pandemic. Interviews were coded in NVivo12 by using a team-based approach. Results The pandemic caused significant mental health burdens but no perceived adverse physical effects, with the U.S. border closure and health care access barriers as more pressing concerns. Participants reported access to information about COVID-19 but had varied levels of knowledge and adherence to disease reduction strategies due to camp conditions. Most participants believed that they had special protection from COVID-19, including strong immune systems or from God. The nongovernmental organizations providing health care and sanitation faced multiple challenges to implement new policies to manage COVID-19. The institution of required temperature checks and quarantine of COVID-19 positive patients led to distrust, decreased seeking of health care services among asylum seekers, and possible underreporting of COVID-19 cases. Conclusion Our findings among asylum seekers in a Matamoros camp highlight the challenges to implementing disease reduction policies in low-resource congregate camps. Policies to address disease outbreaks focusing on the social determinants of health, health care access barriers, and community engagement may be more acceptable to asylum seekers, suggesting the need for effective strategies to provide prevention information that complements such measures.Purpose To examine patients' perceptions of the feasibility, acceptability, and impact of a safety net-based community health worker (CHW) program. Methods Semistructured interviews with patient participants diagnosed with type 2 diabetes (n=13) were analyzed using a traditional text analysis method based on grounded theory. Results This study highlights that the CHW program can improve satisfaction in accessing health services and community resources, and overall health outcomes of patients in safety net practices. Conclusion Patients' overall positive perception of the CHW program suggests that the intervention may be a viable solution to address the health and social needs of patients in safety net settings.Purpose Increasing patient activation facilitates self-management of health, improves health outcomes, and lowers health care expenditures. Extant research notes mixed findings in patient activation by race/ethnicity. The purpose of the study was to examine the relationships among patient activation, select patient characteristics, and glycemic control among Filipino Americans. Methods A cross-sectional study was conducted with a convenience sample of Filipino Americans (n=191), with a diagnosis of diabetes mellitus type 1 or type 2, recruited from a southern California adult primary care clinic between December 2017 and March 2018. Patient activation, select characteristics, and hemoglobin A1c (HbA1c) levels were assessed. Bivariate and logistic regression analyses were used to identify correlates of glycemic control. The Strengthening the Reporting of Observational studies in Epidemiology (STROBE) checklist was used to develop the study. Results Participants with HgbA1C≤7.0% reported statistically higher patient activation measure (13 items) (PAM-13) natural log score (mean [M]=60.
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