Mortalidad operatoria en cirugía mayor. Análisis retrospectivo en un Servicio de Cirugía / Operative mortality in major surgery. Retrospective analysis in a Surgery Service

RESUMEN Introducción: la propia asistencia médica provoca, en determinadas situaciones, problemas de salud que pueden llegar a ser importantes para el enfermo. El análisis de la mortalidad es uno de los parámetros utilizados para investigar la seguridad en la realización de procederes de cirugía mayor. Objetivo: determinar los factores asociados a la mortalidad operatoria en cirugías mayores. Materiales y métodos: se realizó un estudio observacional, descriptivo y retrospectivo, de los pacientes que fallecieron tras la realización de una cirugía mayor, en el Hospital Militar Docente Dr. Mario Muñoz Monroy, de Matanzas, en el período comprendido de enero de 2011 a diciembre de 2019. Resultados: la tercera edad aportó 77,3 % de los fallecidos. La hipertensión arterial, diabetes mellitus y cardiopatía isquémica fueron las principales comorbilidades. El abdomen agudo fue el diagnóstico operatorio más frecuente con 98 (58,3 %). Las complicaciones aportaron el 11,9 % de los fallecidos; los eventos adversos, 29,7 %, y por el curso natural de la enfermedad, murió un 58,3 %. El síndrome de disfunción múltiple de órganos y el shock séptico resultaron las principales causas de muerte (62 %). Conclusiones: la mortalidad operatoria estuvo asociada a factores de riesgo como edad avanzada, enfermedades crónicas y cirugía de urgencia. Los eventos adversos elevan la incidencia de mortalidad en cirugía mayor. Las infecciones son la principal causa de mortalidad operatoria (AU).

ABSTRACT Introduction: medical care itself causes, in certain situations, health problems that could be very important for the patient. The mortality analysis is one of the parameters used to study safety performing procedures of major surgery. Objective: to determine the factors associated to operatory mortality in major surgeries. Materials and methods: a retrospective, descriptive and observational study was carried out of the patients who passed away after undergoing a major surgery in the Military Hospital Dr. Mario Munoz Monroy in the period between January 2011 and December 2019. Results: 77.3 % of the deceased were elder people. The main co-morbidities were arterial hypertension, diabetes mellitus and ischemic heart disease. The most frequent surgery diagnosis was acute abdomen with 98 patients (58.3 %). Complications yielded 11.9 % of the deceases, adverse events 29.7 % and 58.3 % died due to the natural course of the disease. The organs multiple dysfunction syndrome and septic shock were the main causes of dead (62 %). Conclusions: operatory mortality was associated to risk factors like advanced age, chronic diseases and emergency surgery. The adverse events increase mortality incidence in major surgery. Infections are the main causes of operatory mortality (AU).

Examining Whether the Social Cognitive Theory Concepts Predict Childhood Obesity Prevention Outcome Expectations.

The social cognitive theory (SCT) has been used to explain and promote childhood obesity prevention behaviors. We examined whether the SCT concepts predicted outcome expectations of childhood obesity among the children of African American caregivers. Caregivers (n = 128) completed the childhood obesity perceptions paper-based survey. A multiple linear regression was conducted to determine the direct effects of moral disengagement, environment, self-efficacy, and behavioral capability on outcome expectations (p < .05). A mediation analysis using a bootstrapping bias correction method was used to test whether self-efficacy and behavioral capability mediated the effect of moral disengagement and environment on outcome expectations. Caregivers reported high levels of moral disengagement (M = 4.13; standard deviation [SD] = 0.70) and self-efficacy (M = 4.26; SD = 0.64) and moderate levels of behavioral capability (M = 2.83; SD = 0.75) and environment (M = 2.92; SD = 0.74). Findings indicated the hypothesized relationships in the SCT were not fully supported. In addition, the indirect effects of environment on outcome expectations were not statistically significantly mediated by behavioral capability. This research warrants more attention in testing the SCT concepts for the development of childhood obesity prevention efforts that prioritize African American families in rural communities.

Quiste de Gartner de localización uterina / Gartner's cyst of uterine location

RESUMEN Los quistes de los conductos de Gartner, generalmente pequeños, benignos y asintomáticos, son vestigios del canal mesonéfrico de Wolff. Representan el 11 % de los quistes vaginales, esta es su localización más frecuente según la literatura consultada. Se presentó un caso operado en el Hospital Militar de Matanzas "Dr. Mario Muñoz Monroy", de localización en la cara posterior del istmo uterino (AU).

ABSTRAC Gartner's duct cyst, mostly little, benign and asymptomatic, are vestiges of the Wolffian mesonephric duct representing 11 % of the vaginal cysts; this location is the most frequently reported and published one up to date. The authors presented the case of a patient who underwent a surgery in the Military Hospital "Dr. Mario Muñoz Monroy¨ with a cyst in the posterior side of the uterine isthmus (AU).

Parent Perspectives on Health and Functioning of School-Aged Adolescents With Disabilities.

BACKGROUND: Youth living with disabilities are at risk of experiencing poor health outcomes. Coordinated school health programs have an opportunity to help youth with disabilities and their families through health education, health services, and community engagement. The World Health Organization developed the International Classification of Functioning, Disability, and Health (ICF) as a framework to analyze factors related to health conditions. We used the ICF to examine parental perceptions of health and function among students with disabilities living in rural and urban areas. METHODS: We surveyed parents (N = 71) using the parent-report versions of the Pediatric Outcomes Data Collection Instrument and Child Health and Illness Profile. From this group, parents were asked to volunteer to participate in in-depth, individual interviews (N = 18). The interviews were audio-recorded and transcribed verbatim. Researchers used the ICF linking rules to analyze and code the transcriptions. Emergent themes were assigned numerical ICF codes. RESULTS: There were more similarities than differences among rural and urban families. Children living with disabilities face significant environmental barriers regardless of context. CONCLUSIONS: Schools can facilitate education to improve the quality of life of parents and families of children with disabilities. School authorities should consider the many environmental barriers both urban and rural these families face in the community. The ICF can be used as a framework for program planning for community-based, health education for this population.

Enfermedad relacionada con IgG4 a propósito de dos casos / Disease related to IgG4. Apropos of two cases

RESUMEN La enfermedad relacionada con IgG4 (ER-IgG4), es una enfermedad autoinmune multisistémica caracterizada por lesiones fibroesclerosantes inflamatorias formadoras de masas o pseudotumores, concentraciones elevadas de IgG4 séricas e infiltración tisular extensa por células plasmáticas IgG4 positivas. Incluye numerosas entidades que previamente se consideraban órgano-específicas. Puede afectar prácticamente a cualquier órgano, siendo los más afectados páncreas, glándulas salivales, glándulas lacrimales, ganglios linfáticos, retroperitoneo y riñones. El diagnóstico se realiza mediante una combinación de hallazgos clínicos, serológicos, imagenológicos e histopatológicos. Tiene pronóstico reservado pero con un diagnóstico precoz se logra el control y en ocasiones la regresión de la enfermedad, aunque tiende a presentar recaídas. Es una entidad infradiagnosticada debido en parte, a que fue caracterizada recientemente. Se presentan dos casos que forman parte del espectro que abarca esta entidad, la tiroiditis de Riedel y la fibrosis retroperitoneal, que una vez diagnosticados respondieron inicialmente a la terapéutica con altas dosis de corticoides (AU).

ABSTRACT The disease related to IgG4 (ER-IgG4 in Spanish) is a multi-systemic, autoimmune disease characterized by inflammatory fibro-sclerotizing lesions forming masses or pseudo tumors, high concentrations of serum IgG4 and extensive tissue infiltrations by IgG4-positive plasma cells. It includes several entities previously considered organ-specific ones. It can affect almost any organ, being pancreas, salivary glands, lacrimal glands, lymphatic ganglion, retroperineum and kidneys the most affected ones. The diagnosis is made through combining clinical, serologic, imaging and histopathological findings. It has a reserved prognosis but with an early diagnosis its control is reached, and occasionally also the disease's remission, although it tends to have relapses. It is an underdiagnosed disease, partially due to its recent characterization. We present two cases entering the range covered by this disease, the Riedel's thyroiditis and retroperitoneal fibrosis, both initially answering to therapy with high doses of corticoids after diagnosis (AU).

Enfermedad relacionada con IgG4 a propósito de dos casos / Disease related to IgG4. Apropos of two cases

RESUMEN La enfermedad relacionada con IgG4 (ER-IgG4), es una enfermedad autoinmune multisistémica caracterizada por lesiones fibroesclerosantes inflamatorias formadoras de masas o pseudotumores, concentraciones elevadas de IgG4 séricas e infiltración tisular extensa por células plasmáticas IgG4 positivas. Incluye numerosas entidades que previamente se consideraban órgano-específicas. Puede afectar prácticamente a cualquier órgano, siendo los más afectados páncreas, glándulas salivales, glándulas lacrimales, ganglios linfáticos, retroperitoneo y riñones. El diagnóstico se realiza mediante una combinación de hallazgos clínicos, serológicos, imagenológicos e histopatológicos. Tiene pronóstico reservado pero con un diagnóstico precoz se logra el control y en ocasiones la regresión de la enfermedad, aunque tiende a presentar recaídas. Es una entidad infradiagnosticada debido en parte, a que fue caracterizada recientemente. Se presentan dos casos que forman parte del espectro que abarca esta entidad, la tiroiditis de Riedel y la fibrosis retroperitoneal, que una vez diagnosticados respondieron inicialmente a la terapéutica con altas dosis de corticoides (AU).

ABSTRACT The disease related to IgG4 (ER-IgG4 in Spanish) is a multi-systemic, autoimmune disease characterized by inflammatory fibro-sclerotizing lesions forming masses or pseudo tumors, high concentrations of serum IgG4 and extensive tissue infiltrations by IgG4-positive plasma cells. It includes several entities previously considered organ-specific ones. It can affect almost any organ, being pancreas, salivary glands, lacrimal glands, lymphatic ganglion, retroperineum and kidneys the most affected ones. The diagnosis is made through combining clinical, serologic, imaging and histopathological findings. It has a reserved prognosis but with an early diagnosis its control is reached, and occasionally also the disease’s remission, although it tends to have relapses. It is an underdiagnosed disease, partially due to its recent characterization. We present two cases entering the range covered by this disease, the Riedel’s thyroiditis and retroperitoneal fibrosis, both initially answering to therapy with high doses of corticoids after diagnosis (AU).

Assessing Child Body Mass Index Perceptions Among African American Caregivers in a Rural Community.

In the USA, African American children residing in rural areas are disproportionately affected by childhood obesity. One strategy for preventing childhood obesity is helping caregivers to recognize their child is overweight or obese. The purpose of this study is to assess African American caregivers' perceived level of their child's obesity status and concordance between caregiver's reported height and weight of their children compared to the objective measure of their child's height and weight. Caregivers completed a paper-based survey about perceptions of their child's weight status including body silhouettes (n = 119) and self-reported their child's body mass index status (n = 68). Children's (n = 71) height and weight were objectively measured. Spearman rho and independent sample t tests were calculated to assess the relationship between caregiver's self-reported and objective BMI status. Caregiver's visually perceived their child's weight status to be underweight; yet, self-reported that their child's body mass index status was obese. The Spearman's rho correlation indicated a significant relationship between caregiver's self-reported and objective body mass index (r = .39, p < .001). The independent sample t test reflected that the mean self-reported body mass index and objective body mass index were statistically significant with calculated body mass index perception. The investigation of three different methods for assessing body mass index perceptions may contribute to the development of tailored programs and interventions that include counseling strategies that increase parental education about their child's body mass index.

Comportamiento de la hemorragia digestiva alta en el quinquenio 2009 a 2013 / Behavior of the high digestive bleeding in the five-year period 2009-2013

Introducción: la hemorragia digestiva alta constituye un problema frecuente de salud en el mundo; así se comporta en Cuba, en la provincia Matanzas y en el hospital de estudio. Actualmente es considerada como causa mayor de morbimortalidad. Objetivo: determinar el comportamiento de la hemorragia digestiva alta en el Hospital Militar de Matanzas. Materiales y Métodos: se realizó una investigación descriptiva, en un periodo de cinco años que incluyó a todos los pacientes ingresados con ese diagnóstico, y los que durante su ingreso por otra causa presentaron episodios de hemorragia. El índice de Rockall permitió evaluar la necesidad de cirugía, recidiva y mortalidad. Resultados: la mayoría de los pacientes pertenecieron al grupo de riesgo intermedio. Los hombres fueron los más afectados, el grupo de tercera edad presentó mayor incidencia. La gastritis hemorrágica fue la primera causa de sangrado. La hipertensión arterial resultó ser el factor de riesgo relevante y el tabaquismo el hábito tóxico más frecuente. Conclusiones: como beneficio relevante se demostró la importancia de la endoscopia precoz para el diagnóstico de la causa, tratamiento y pronóstico de la hemorragia. Se observó una buena correlación entre el pronóstico del paciente al ingreso y su estado al final del tratamiento (AU).

Introduction: the high digestive hemorrhage is a frequent health problem in the world; it behaves the same in Cuba, in the province of Matanzas and in the hospital where the study was carried out. Currently it is considered a major cause of morbi-mortality. Objective: to determine the behavior of the high digestive bleeding in the Military Hospital of Matanzas. Materials and Methods: a descriptive research was carried out in a five-year period. It included all the patients admitted with that diagnosis and those who presented episodes of hemorrhage even if they were admitted by any other cause. The Rockall index allowed to assess the necessity of surgery, the recidivism and mortality. Results: most of the patients belonged to the intermediate risk group. Male patients were the most affected one; the group of elder people showed higher incidence. Hemorrhagic gastritis was the first cause of bleeding. Arterial hypertension was the relevant risk factor and smoking the most frequent toxic habit. Conclusions: as a relevant benefit it was showed the importance of precocious endoscopy for the diagnosis of the hemorrhage cause, treatment and prognosis. It was observed a good correlation between the patient´s prognosis at the admission and his status at the end of the treatment (AU).

Comportamiento de la hemorragia digestiva alta en el quinquenio 2009 a 2013 / Behavior of the high digestive bleeding in the five-year period 2009-2013

Introducción: la hemorragia digestiva alta constituye un problema frecuente de salud en el mundo; así se comporta en Cuba, en la provincia Matanzas y en el hospital de estudio. Actualmente es considerada como causa mayor de morbimortalidad. Objetivo: determinar el comportamiento de la hemorragia digestiva alta en el Hospital Militar de Matanzas. Materiales y Métodos: se realizó una investigación descriptiva, en un periodo de cinco años que incluyó a todos los pacientes ingresados con ese diagnóstico, y los que durante su ingreso por otra causa presentaron episodios de hemorragia. El índice de Rockall permitió evaluar la necesidad de cirugía, recidiva y mortalidad. Resultados: la mayoría de los pacientes pertenecieron al grupo de riesgo intermedio. Los hombres fueron los más afectados, el grupo de tercera edad presentó mayor incidencia. La gastritis hemorrágica fue la primera causa de sangrado. La hipertensión arterial resultó ser el factor de riesgo relevante y el tabaquismo el hábito tóxico más frecuente. Conclusiones: como beneficio relevante se demostró la importancia de la endoscopia precoz para el diagnóstico de la causa, tratamiento y pronóstico de la hemorragia. Se observó una buena correlación entre el pronóstico del paciente al ingreso y su estado al final del tratamiento (AU).

Introduction: the high digestive hemorrhage is a frequent health problem in the world; it behaves the same in Cuba, in the province of Matanzas and in the hospital where the study was carried out. Currently it is considered a major cause of morbi-mortality. Objective: to determine the behavior of the high digestive bleeding in the Military Hospital of Matanzas. Materials and Methods: a descriptive research was carried out in a five-year period. It included all the patients admitted with that diagnosis and those who presented episodes of hemorrhage even if they were admitted by any other cause. The Rockall index allowed to assess the necessity of surgery, the recidivism and mortality. Results: most of the patients belonged to the intermediate risk group. Male patients were the most affected one; the group of elder people showed higher incidence. Hemorrhagic gastritis was the first cause of bleeding. Arterial hypertension was the relevant risk factor and smoking the most frequent toxic habit. Conclusions: as a relevant benefit it was showed the importance of precocious endoscopy for the diagnosis of the hemorrhage cause, treatment and prognosis. It was observed a good correlation between the patient´s prognosis at the admission and his status at the end of the treatment (AU).

Application of mixed-methods design in community-engaged research: Lessons learned from an evidence-based intervention for Latinos with chronic illness and minor depression.

The purpose of this paper is to share lessons learned from a collaborative, community-informed mixed-methods approach to adapting an evidence-based intervention to meet the needs of Latinos with chronic disease and minor depression and their family members. Mixed-methods informed by community-based participatory research (CBPR) were employed to triangulate multiple stakeholders' perceptions of facilitators and barriers of implementing the adapted intervention in community settings. Community partners provided an insider perspective to overcome methodological challenges. The study's community informed mixed-methods: research approach offered advantages to a single research methodology by expanding or confirming research findings and engaging multiple stakeholders in data collection. This approach also allowed community partners to collaborate with academic partners in key research decisions.

Do Maternal Caregiver Perceptions of Childhood Obesity Risk Factors and Obesity Complications Predict Support for Prevention Initiatives Among African Americans?

Objectives African American maternal caregiver support for prevention of childhood obesity may be a factor in implementing, monitoring, and sustaining children's positive health behaviors. However, little is known about how perceptions of childhood obesity risk factors and health complications influence caregivers' support of childhood obesity prevention strategies. The objective of this study was to determine if childhood obesity risk factors and health complications were associated with maternal caregivers' support for prevention initiatives. Methods A convenience sample of maternal caregivers (N = 129, ages 22-65 years) completed the childhood obesity perceptions (COP) survey. A linear regression was conducted to determine whether perceptions about childhood obesity risk factors and subsequent health complications influenced caregivers' support for prevention strategies. Results Caregivers' perceptions of childhood obesity risk factors were moderate (M = 3.4; SD = 0.64), as were their perceptions of obesity-related health complications (M = 3.3; SD = 0.75); however, they perceived a high level of support for prevention strategies (M = 4.2; SD = 0.74). In the regression model, only health complications were significantly associated with caregiver support (ß = 0.348; p < 0.004). Conclusions Childhood obesity prevention efforts should emphasize health complications by providing education and strategies that promote self-efficacy and outcome expectations among maternal caregivers.

Salud es Vida: a Cervical Cancer Screening Intervention for Rural Latina Immigrant Women.

This study examined the feasibility and efficacy of Salud es Vida-a promotora-led, Spanish language educational group session on cervical cancer screening (Pap tests)-self-efficacy (belief in ability to schedule and complete a Pap test), and knowledge among immigrant Hispanic/Latina women from farmworker backgrounds. These women are disproportionately burdened with cervical cancer, with mortality rates significantly higher than non-Hispanic whites. The two-arm, quasi-experimental study was conducted in four rural counties of Southeast Georgia in 2014-2015. Hispanic/Latina immigrant women aged 21-65 years and overdue for a Pap test were included as intervention (N = 38) and control (N = 52) group participants. The intervention was developed in partnership with a group of promotoras to create the toolkit of materials which includes a curriculum guide, a brochure, a flipchart, a short animated video, and in-class activities. Twelve (32 %) intervention group participants received the Pap test compared to 10 (19 %) control group participants (p = 0.178). The intervention group scored significantly higher on both cervical cancer knowledge recall and retention than the control group (p < 0.001). While there was no statistically significant difference in cervical cancer screening self-efficacy scores between the group participants, both groups scored higher at follow-up, adjusting for the baseline scores. The group intervention approach was associated with increased cervical cancer knowledge but not uptake of Pap test. More intensive interventions using patient navigation approaches or promotoras who actively follow participants or conducting one-on-one rather than group sessions may be needed to achieve improved screening outcomes with this population.

The Determinants of Physical Activity in Rural Women, Aged 20 to 44 Years, in Georgia.

Physical activity rates in rural women are very low. The purpose of this study was to explore the determinants of physical activity in rural women aged 20 to 44 years. A survey was used to collect data on a cluster sample of 184 participants. This study was guided by Self-Determination Theory. Survey data suggest that the highest type of motivation was identified regulation, and husband's support had the strongest effect on physical activity. Findings suggest that a history of sports participation can lead to the formation of intrinsic motivation. The results will assist in developing effective physical activity interventions.

Translating Research into Practice: Employing Community-Based Mixed Methods Approaches to Address Chronic Disease and Depression Among Latinos.

The co-occurrence of depression and chronic diseases is often under-recognized, under-treated, and under-studied. Among Latinos, complex structural and cultural barriers exist which complicate the translation of chronic disease self-management programs (CDSMP) for this population. To better understand those barriers and deliver a CDSMP designed to best meet local needs, a community-based, mixed methods study was designed. Formative research was conducted through focus groups with Latinos with chronic illness and minor depression (ICD) and family members to obtain insight into perceived needs and interviews with stakeholders to assess barriers and facilitators to the adoption of CDSMPs. Analytic Hierarchy Process was employed to determine core elements of a CDSMP for ICDs, family members, and the promotores who deliver these programs. Findings guided the transcreation of a CDSMP. This study offers a promising model for enhancing the effects of evidence-based interventions and emphasizes the importance of meeting differing needs within the local population.

Development and psychometric testing of the childhood obesity perceptions (COP) survey among African American caregivers: A tool for obesity prevention program planning.

Currently, public health practitioners are analyzing the role that caregivers play in childhood obesity efforts. Assessing African American caregiver's perceptions of childhood obesity in rural communities is an important prevention effort. This article's objective is to describe the development and psychometric testing of a survey tool to assess childhood obesity perceptions among African American caregivers in a rural setting, which can be used for obesity prevention program development or evaluation. The Childhood Obesity Perceptions (COP) survey was developed to reflect the multidimensional nature of childhood obesity including risk factors, health complications, weight status, built environment, and obesity prevention strategies. A 97-item survey was pretested and piloted with the priority population. After pretesting and piloting, the survey was reduced to 59-items and administered to 135 African American caregivers. An exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) was conducted to test how well the survey items represented the number of Social Cognitive Theory constructs. Twenty items were removed from the original 59-item survey and acceptable internal consistency of the six factors (α=0.70-0.85) was documented for all scales in the final COP instrument. CFA resulted in a less than adequate fit; however, a multivariate Lagrange multiplier test identified modifications to improve the model fit. The COP survey represents a promising approach as a potentially comprehensive assessment for implementation or evaluation of childhood obesity programs.

"When everything changes:" Parent perspectives on the challenges of accessing care for a child with a disability.

BACKGROUND: Health disparities exist among individuals living in rural and urban contexts in terms of access to health care and overall mortality. These disparities are typically greater for youth with disabilities living in rural areas, who face additional barriers in receiving health and support services specific to their disability. Parents are typically the ones responsible for coordinating the care needed by children with a disability; however, with numerous barriers present families are not provided adequate support to care for a child with disabilities. OBJECTIVE: The purpose of this study was to examine barriers and facilitators to accessing health and support services among urban and rural families of children with disabilities. METHODS: In-depth interviews were conducted with parents who provide care for an adolescent with a disability. The sample was comprised of parents from one rural county (N = 9) and one urban county (N = 10) in Georgia. Parental interviews were conducted face to face by a trained researcher. Each interview was audio-recorded. The recordings were transcribed and content analysis used to create codes and identify emerging themes. RESULTS: The common themes found during the analysis include accessibility of health and support resources, transitions, and social isolation. CONCLUSIONS: When comparing urban and rural areas, barriers to access do differ in terms of availability, but analysis revealed more similarities existed among parents from both contexts. Efforts must be made to increase opportunities for youth with disabilities to become connected with the local community in order to improve quality of life for families.

Grandparent caregiving among rural African Americans in a community in the American South: challenges to health and wellbeing.

INTRODUCTION: An increasing number of grandparents in rural USA are serving as primary caregivers for their grandchildren because of parental incarceration, addiction, joblessness, or illness. Low-income, African American women from the South are overrepresented in this growing population. There is a paucity of research exploring the challenges faced by rural grandparent caregivers, and past studies have not explicitly addressed the potential consequences of rural grandparent caregiving for health. The purpose of this qualitative study was to explore grandparent caregiving among rural, low-income, African American grandmothers in a community in the American South, and to identify challenges to health that arose in that context. McLeroy's social ecological model (SEM) was used to examine these challenges at multiple levels of influence. METHODS: This qualitative interview-based study was conducted in a high-poverty community in rural Georgia. In-depth interviews were conducted with African American grandparent caregivers and key informants from local community-based organizations. A key informant assisted in identifying initial interview participants, and then snowball sampling was used to recruit additional participants. Interview questions were grouped under five domains (intrapersonal, interpersonal, community, organizational, and policy), according to the levels of the SEM. Iterative content analysis of interview transcripts was utilized. Transcripts were coded to identify text segments related to each domain of the SEM, which were grouped together for analysis by domain. Reflexive memo-writing aided in development of themes, and data quality was assessed using Lincoln and Guba's trustworthiness criteria. RESULTS: Rural African American grandparent caregivers faced a range of challenges to health. Direct physical challenges included chronic pain that interfered with sleep and daily functioning, mobility issues exacerbated by child care, and the pressure of managing their own medical conditions as well as their grandchildren's. Financial scarcity added to their vulnerability to poor health outcomes, especially when caregivers would forego purchase of medications or visits to the doctor because of expenses related to their grandchildren. In addition, lack of child care made health appointments and hospitalizations logistically difficult. Emotional strain was common as grandparent caregivers struggled to protect their grandchildren in communities where rates of drug use, HIV, and incarceration were high. Caregivers worried about their mortality and the related consequences for their grandchildren. Chronic stress, which is linked to a number of poor health outcomes, was self-reported by most rural grandparent caregivers. CONCLUSIONS: In this study, the challenges of rural grandparent caregiving among African American women posed multiple threats to health and wellbeing. Further research is needed, in different rural contexts and with different caregiver populations, to more thoroughly examine the health risks of grandparent caregiving. In addition, the development of multi-faceted interventions and programs will be critical to meeting the needs of rural grandparent caregivers. A few models for such programs exist, although resource shortfalls have often limited their impact.

The Willow Hill Community Health Assessment: Assessing the Needs of Children in a Former Slave Community.

The overall purpose of this community needs assessment was to explore the perceptions of health and educational needs among youth residing in a rural Georgia community, document existing assets that could be utilized to meet those needs, and to identify socioeconomic barriers and facilitators in health education. A sequential mixed method design was used. Intercept surveys were conducted followed by individual, key informant interviews and a focus group. Survey data was entered into an Excel spreadsheet and SPSS for analysis and descriptive statistics including means and frequencies were calculated. For qualitative interviews, full transcripts were created from audio-recordings and uploaded into NVivo for content analysis. Several health issues were highlighted by the Willow Hill/Portal Georgia community members, including teachers, parents, youth and Willow Hill Heritage and Renaissance Center board members. Some of the health issues identified by youth in the community were low levels of physical activity, obesity, diabetes, lack of healthy food choices, and access to health care services. Including the issues identified by youth, the parents, teachers and board members identified additional health issues in the community such as asthma, hygiene and lack of dental and eye care facilities. Overall, there is a need for better infrastructure and awareness among community members. Utilizing identified assets, including active community leaders, involved faith-based organizations, commitment of community members, presence of land resources, and commitment to physical activity and sports, could modify the current community landscape.

Preschool children's self-reports of fruit and vegetable knowledge, preference, and messages encouraging consumption.

BACKGROUND: Fruit and vegetable consumption (FVC) is associated with a reduced risk of diabetes, obesity, cancer, and cardiovascular disease. Only one third of children aged 4-8years consume the recommended 5 servings a day. Studies involving school-aged children (6-11 years) demonstrate that positive outcome expectancies can mediate FVC. There is a lack of similar studies involving preschool-aged (<5 years) children. The purpose of this study was to assess preschool children's knowledge and preference of fruits and vegetables, messages they recall hearing related to FVC, and how they perceive these messages. METHODS: Children (N = 192) were individually interviewed with a play-based picture card game followed by a mealtime environment reenactment open-ended interview. Fruit and vegetable messages were operationalized using Social Cognitive Theory (SCT). Descriptive statistics and associations are reported. RESULTS: Each child recalled an average of 2.27 messages associated with FVC. Positive outcome expectancies, negative outcome expectancies, and prompts were most frequently recalled. Statistically significant differences in knowledge, preference, and messages were observed based on income. CONCLUSIONS: Children as young as age 4 years understand positive outcome expectancies. Experimental trials are warranted to determine if tailored expectancy messages mediate FVC among preschool children.

Cultural beliefs and understandings of cervical cancer among Mexican immigrant women in Southeast Georgia.

Rural Mexican immigrant women in the U.S. are infrequently screened and experience health disparities from cervical cancer. We explored cancer-related cultural beliefs in this population. We administered a cross-sectional survey to 39 Mexican immigrant women due for screening. We conducted univariate and bivariate analyses of participants' characteristics, Pap test history, cancer-related knowledge and beliefs, and cultural consensus analysis about causes of cervical cancer and barriers to screening. For all the cultural consensus tasks, there was consensus (Eigenratios >3:1) among survey participants. Comparing the rankings of risk factor clusters, clusters related to sexual behaviors were ranked more severely than clusters related to genetic or other behavioral factors. There was agreement on ideas of cervical cancer causation and barriers to screening among these women. Hence, improved methods of disseminating important health information and greater access to care are needed, particularly in relationship to stigma about sex and birth control practices.