Se Habla Español: The role of ethnic centrality in the effect of providing Spanish-language services in health clinics among Latinx Americans.

The present work experimentally examines whether a Spanish-speaking healthcare provider (an identity safety cue) increases the anticipated quality of care and healthcare utilization intentions of Latinx Americans (N = 180) and whether this effect is moderated by ethnic centrality. We find that providing Spanish-language services, versus not, on a healthcare facility's webpage significantly increases both anticipated quality of care and healthcare utilization intentions-but only for Latinx Americans who perceive their ethnicity as highly central to their self-concept. Likewise, we find that anticipated quality of care mediates the effect that identity safety cues have on healthcare utilization intentions only for Latinx Americans high on ethnic centrality. These findings demonstrate that members of minoritized ethnic groups shown to be the most susceptible to experiencing concerns of discrimination (people high on ethnic centrality) are also the most likely to benefit from identity safety cues that are designed to mitigate these very concerns.

Multicenter analysis to assess risk of major adverse cardiac events in patients undergoing high-sensitivity troponin testing in the emergency department.

Study hypothesis: Our objective was to evaluate 30-day major adverse cardiac events (MACE) in emergency department (ED) patients with normal high-sensitivity troponins (hs-trop). We hypothesized that MACE rates would be <1% in patients with (1) two normal troponins regardless of change in troponin (delta) and (2) index hs-trop below the limit of quantitation (LOQ) regardless of the institution modified HEART score. Methods: This was a multicenter, retrospective, cohort study of adult patients who presented to 1 of 18 EDs between July 2020 and April 2021 with acute coronary syndrome as defined by an institutional-modified HEART score completed by their treating physician or midlevel, no evidence of ST-elevation myocardial infarction, and an index or serial gender-adjusted hs-trop within normal limits. The primary outcome was MACE within 30 days of index ED encounter. A detailed case review was then performed for those patients experiencing a MACE. Results: Of the 9084 patients who had single or serial normal troponins, 31 (0.34%; confidence interval [CI] 0.23%-0.48%) experienced MACE. Of the 6140 patients with 2 normal hs-trop and a delta (change in troponin) <4, 27 patients (0.44%; CI 0.29%-0.64%) experienced MACE. Only 1 of the 69 patients with 2 normal hs-trop results but delta (change in troponin) ≥ 4 (1.45%; CI 0.04%-7.81%) suffered MACE. This patient was classified as non-low risk by our institutional HEART score. Of 7498 patients with an index hs-trop 

Neighborhood ethnic composition and social identity threat: the mediating role of perceived discrimination.

Ethnic proportions of neighborhoods are a "macro" measure of intergroup contact and can buffer or expose people of color to discrimination. Simultaneously, perceived discrimination can sensitize students of color to social identity threat in environments in which they are numerically underrepresented and negatively stereotyped. In the current research, we integrate these two lines of research to examine whether neighborhood ethnic composition - the percentage of Latinx residents in one's home community - predicts social identity threat for Latinx students attending college at a predominately White institution (PWI). In two studies, Latinx college students attending a PWI provided their 5-digit zip code and completed measures assessing their perceived discrimination and social identity threat. Across both studies, neighborhood ethnic composition (greater percentage of Latinx residents) was associated with greater social identity threat and this association was mediated by greater perceived discrimination. These studies advance research on neighborhood ethnic composition and social identity threat.

Visible and Concealable Stigmatized Identities and Mental Health: Experiences of Racial Discrimination and Anticipated Stigma.

Experiencing and anticipating discrimination because one possesses a visible (e.g., race) or concealable (e.g., mental illness) stigmatized identity has been related to increased psychological distress. Little research, however, has examined whether experiencing and anticipating discrimination related to possessing both a visible and concealable stigmatized identity (e.g., a racial/ethnic minority with a history of mental illness) impacts mental health. In the current study, we test two hypotheses. In the first, we examine whether experienced discrimination due to a visible stigma (race/ethnicity) and anticipating stigma due to a concealable stigma (e.g., substance abuse) each predict unique variance in depressive symptomatology. In the second, we examine whether experienced discrimination due to a visible stigma is related to greater anticipated stigma for a concealable stigma, which in turn is related to more depression. A total of 265 African American and Latinx adults who reported concealing a stigmatized identity at least some of the time completed measures of racial/ethnic discrimination, anticipated stigma of a concealable stigmatized identity, and depressive symptomatology. Results of a simultaneous linear regression revealed that increased racial/ethnic discrimination and anticipated stigma independently predicted greater depressive symptomatology (controlling for each other). A mediation analysis showed that the positive association between increased racial/ethnic discrimination and higher depressive symptomatology was partially mediated by greater anticipated stigma. These results demonstrate that a person can experience increased psychological distress from multiple types of stigma separately, but also may anticipate greater stigma based on previous experiences of racial discrimination, which in turn relates to increased distress.

Disclosure and concealment of stigmatized identities.

People with concealable stigmatized identities face decisions on whether, when, and to whom to disclose their stigmatized status. Research has shown that disclosing one's identity yields benefits to the individual such as greater social support and increased physical and psychological health outcomes. However, further examination shows greater nuance in the matter: Some disclosures are related to more negative health outcomes, particularly when the response to the disclosure and/or the environment are/is more hostile. Moreover, recent research shows that the active concealment of a stigmatized identity may be a more reliable predictor of psychological well-being than whether a person has disclosed. Future research should consider intersecting identities, as well as the broader consequences of living with a concealable stigmatized identity.

Anticipated HIV-Related Stigma and HIV Treatment Adherence: The Indirect Effect of Medication Concerns.

Although anticipated HIV-related stigma-the expectation that one will experience prejudice and discrimination in the future as a result of others learning his or her HIV positive status-is theorized to be a robust predictor of antiretroviral therapy (ART) non-adherence, the association between anticipated stigma and ART non-adherence has been inconsistent. It may be, however, that anticipated stigma reliably, but indirectly, contributes to poor ART adherence through other psychosocial mechanisms. In the current study, we examine whether anticipated stigma indirectly contributes to treatment non-adherence through increased medication concerns. In a cross-sectional study, 585 people living with HIV in Atlanta and Macon, Georgia completed measures of anticipated HIV-related stigma, HIV-medication concerns, and HIV-treatment adherence. A latent variable mediation analysis revealed that anticipated stigma was positively associated with increased medication concerns, which consequently contributed to treatment non-adherence. Results reveal a psychosocial mechanism by which anticipated stigma contributes to ART non-adherence.

Caracterización de los defectos refractivos en una población de niños de los 2 a los 14 años en Bogotá, Colombia / Characterization of Refractive Defects in a Population of Children Aged from 2 to14 years in Bogotá, Colombia

Introducción: Los defectos refractivos pueden repercutir de manera importante en el rendimiento de un individuo, sobre todo en la población pediátrica. Objetivo: Determinar la prevalencia de defectos refractivos en una muestra de 112 niños entre los 2 y los 14 años del Colegio La Candelaria, en la ciudad de Bogotá. Métodos: Estudio de corte transversal que valoró, por medio de la agudeza visual, motilidad ocular, oftalmoscopia, retinoscopia y examen subjetivo, la capacidad visual de los niños en cuestión. Resultados: Se encontró una prevalencia de defectos refractivos del 18,8 %, dentro de la cual el 13,4 % representaba astigmatismo; el 3,6%, hipermetropía, y el 1,8%, miopia. Discusión: Se compararon los resultados con aquellos de una tesis realizada en 1973, donde se estudiaron pacientes en condiciones similares. En esta, la prevalencia de defectos refractivos fue del 30,48 %, diferencia que se podría explicar por la variación de características poblacionales. Por último, se plantea la necesidad de tamizaje en otras comunidades.

Introduction: The refractive defects can have a great amount of repercussions in the performance of the individual, especially in the pediatric community. Objective: To determine the prevalence of refractive defects within a sample of 112 children between the ages of 2 and 14 from Colegio La Candelaria in the city of Bogotá. Methods: Cross-sectional study that valued through visual acuity, ocular motility, ophthalmoscopy, retinoscopy, and subjective exam, the visual capacity of the children in question. Results: We have found a prevalence of refractive defects of 18.8% were 13.4% represented astigmatism, 3.6% farsightedness and 1.8% shortsightedness. Discussion: These results were compared with those from a thesis performed in 1973 were patients with similar conditions were tested. In this one, the refractive defects were of 30.48%, a difference that can be explained by variations in population characteristics. Lastly, it arises the need of screening in other communities.

Opportunities for involving men and families in chronic disease management: a qualitative study from Chiapas, Mexico.

BACKGROUND: A healthy lifestyle intervention was implemented in primary care health centers in urban parts of Tuxtla Gutiérrez, Chiapas, Mexico with an aim of reducing cardiovascular disease risk for patients with type 2 diabetes and/or hypertension. During implementation, research questions emerged. Considerably fewer men participated in the intervention than women, and an opportunity was identified to increase the reach of activities aimed at improving disease self-management through strategies involving family members. A qualitative study was conducted to identify strategies to involve men and engage family members in disease management and risk reduction. METHODS: Nine men with hypertension and/or type 2 diabetes with limited to no participation in disease self-management and health promotion activities, six families in which at least one family member had a diagnosis of one or both conditions, and nine health care providers from four different government health centers were recruited for the study. Participants took part in semi-structured interviews. During interviews with families, genograms and eco-maps were used to diagram family composition and structure, and capture the nature of patients' relationships to the extended family and community resources. Transcripts were coded and a general inductive analytic approach was used to identify themes related to men's limited participation in health promotion activities, family support and barriers to disease management, and health care providers' recommendations. RESULTS: Participants reported barriers to men's participation in chronic disease management and healthy lifestyle education activities that can be grouped into two categories: internal and external factors. Internal factors are those for which they are able to make the decision on their own and external factors are those that are not related solely to their decision to take part or not. Four primary aspects were identified related to families' relationships with disease: different roles within the family, types of support provided to patients, the opportunity to prevent disease among family members without a diagnosis, and - in some cases - lack of family support or stress-induced by other family members. There was an overlap in recommended strategies for engaging men and family members in chronic disease management activities. CONCLUSIONS: There is an opportunity to increase the reach of interventions aimed at improving disease self-management by engaging men and family members. The proposed strategies presented by patients, family members, and providers have implications for health education and service provision at primary care health centers and for future research.

[Mortality of interventricular septum rupture after acute myocardial infarction with surgical management]. / Mortalidad de la ruptura de septum interventricular posterior a infarto agudo del miocardio con manejo quirúrgico.

BACKGROUND: ventricular septal rupture is a rare complication of myocardial infarction. It is considered the most serious mechanical disturbance in these cases. The mortality of patients during the hospital period receiving surgical treatment for this complication is described. METHODS: a case series study, including patients with ventricular septal rupture posterior to myocardial infarction, detected with a retrospective review of records of patients subjected to surgical repair from December 2005 to December 2010. RESULTS: a total of 20 patients were included, with an average age of 56 years (48-65 years), male gender in 16 cases (80%), and a male: female relation of 4:1. Ten (50%) of the patients died; five due to multiple organ failure, one from nosocomial pneumonia, two from ventricular fibrillation, and two from refractory shock secondary to biventricular failure during the surgery. The factors identified for poor prognosis were the average time of 145 minutes on cardiopulmonary bypass, and acute kidney injury in six cases, requiring replacement therapy. CONCLUSIONS: ventricular septal rupture is a rare complication with a high mortality. Without surgical treatment mortality can reach almost 100%. The mortality of this pathology treated with surgical closing in our hospital was 50%, similar to other published reports. Our findings confirm that although surgery for ventricular septal rupture has a high mortality it should be carried out because it is a surgical emergency.

Cochabamba y la nueva conciencia sobre el agua / En

El presente trabajo pretende realizar un analisis sobre el aporte que a nivel internacional ha podido generar la guerra del agua en Cochabamba,tomando en cuenta los diversos problemas que se manifiestan sobre el uso y aprovechamiento de los recursos hidricos

Operación de Hartmann: experiencia institucional de 92 casos consecutivos / Hartmann's procedure: institutional experience of 92 consecutive cases

Antecedentes: desde su descripción en 1923, el procedimiento de Hartmann es ampliamente utilizado en el tratamiento quirúrgico de complicaciones agudas del colon izquierdo, cuando no es posible realizar lavado mecánico preoperatorio y/o cuando Objetivo: analizar los resultados de la operación de Hartmann en el tratamiento quirúrgico de pacientes consecutivos en una misma institución, durante un intervalo de 30 meses.existe alta posibilidad de dehiscencia anastomótica.Tipo de estudio: prospectivo, no al azar y longitudinal.Material y métodos: pacientes tratados mediante procedimiento de Hartmann entre marzo de 1995 y septiembre de 1998. Se realizó análisis de indicación del procedimiento, hallazgos transoperatorios, morbilidad y mortalidad, así como la frecuencia de reversión con reinstalación de la continuidad intestinal y su morbimortalidad.Resultados: se sometieron al procedimiento de Hartmann 92 pacientes. La edad promedio de los pacientes fue de 60 + 25 años (margen de 21 a 88 años) y 60 por ciento superaba los 65 años de edad. El procedimiento fue de urgencia en 91 por ciento de los casos. Los pacientes presentaban en su mayoría sepsis intraabdominal (56 por ciento) y patología colónica benigna (83 por ciento). Se detectó morbilidad de 34 por ciento y mortalidad de 19 por ciento. Durante el seguimiento se restauró la continuidad intestinal en 32 por ciento de los casos sin ocurrir fatalidades.Conclusiones: el procedimiento de Hartmann es buena opción para el tratamiento quirúrgico no electivo de patología rectosigmoidea complicada. La morbilidad y la mortalidad de la operación depende en gran medida del grado de sepsis preoperatoria y de la condición preexiste del paciente. La baja tasa de restauración en la continuidad intestinal probablemente se debe a un corto tiempo de seguimiento