Learning to Communicate: A Photovoice Study With Intensive Care Residents During Night Shifts in the Intensive Care Unit.

This study explored the learning experiences of intensive care residents in an intensive care unit (ICU) during night shifts and the development of communication skills in this community of practice. This action research qualitative study used the photovoice method in four workshops. A group of nine residents shared their learning experiences and collectively analyzed, built, and presented proposals to improve residents' communication skills in the community of practice in which they become intensivists. Participatory thematic analysis was conducted. Students concluded that night shifts in the ICU offered a perfect situational learning environment for communication with one-on-one resident-teacher relationships, less administrative work, and more resident responsibility, improving intensivist identity. Role models, reflective thinking, and teamwork are essential for fostering communication skills among intensivist community members and are all trainable. The results and student suggestions were presented to teachers and decision-makers in the clinic. These photovoice strategies developed students' abilities to share their critical views and suggestions with decision-makers for subsequent implementation, enhancing their confidence in their learning process, strengthening trust-based relationships with teachers, and improving future intensivists' practice communities.

Latino immigrants, discrimination and reception in Columbus, Ohio.

Columbus, Ohio has witnessed rapid growth in its Latino population as immigrants settle in the city to access jobs and a generally low cost of living. Immigrants also face discrimination as they settle in Columbus and interact with the city's citizens. In this paper, we note how discrimination plays out in social and economic isolation; a lack of programs to support the incorporation of Latinos in the city; and state laws that target immigrants. We present results of ongoing ethnographic work with the Latino community in Columbus.

Pretreatment with glycomacropeptide reduces allergen sensitization, alleviates immediate cutaneous hypersensitivity and protects from anaphylaxis.

Allergic disorders are characterized by the involvement of allergen-specific immunoglobulin (Ig)E antibodies and T helper type 2 (Th2) cells. The search for new therapies for allergic diseases has been the primary focus of interest for many investigators in recent years. Glycomacropeptide (GMP) is a biologically active component of milk that exhibits a range of immunomodulatory functions. We examined whether oral administration of GMP could affect the development of allergic sensitization and the severity of immediate cutaneous hypersensitivity reactions and of anaphylaxis. Rats treated with or without GMP were ovalbumin (OVA)-sensitized and several indicators of allergy were evaluated. Pretreatment with GMP resulted in reduction of antigen-specific IgE titre in rats when sensitized with OVA. GMP administration also markedly suppressed the proliferative response of splenocytes to antigen and the production of interleukin (IL)-13 by splenocytes of sensitized animals. In addition, GMP pretreatment attenuated the intensity of the immediate cutaneous reaction induced by antigen and protected the sensitized rats from severe anaphylaxis. These data demonstrate, for the first time, that the administration of GMP prevents allergen sensitization and reduces the severity of the early-phase reaction induced by antigen in cutaneous hypersensitivity and in anaphylaxis. GMP may be used as a novel prophylactic agent for the control of allergic diseases.

Genotipificación y resistencia antibacteriana de cepas de Campylobacter spp aisladas en niños y en aves de corral / Genotyping and antibacterial resistance of Campylobacter spp strains isolated in children and in free range poultry

Poultry is a main reservoir and source of human infection in campylobacteriosis. Three hundred and forty one stool samples (291 human, 50 avian) were analyzed. In the human group, 220 samples were collected from children with acute diarrheal disease (183 inpatients, 37 outpatients) and 71 from healthy children. Erythromycin and ciprofloxacin agar dilution MIC tests, Penner serotyping and RAPD-PCR genotyping were performed on 23 strains isolated. C. jejuni was reported only in patients with acute diarrhea (5.4 percent inpatients, 2.2 percent outpatients). Campylobacter prevalence in poultry was 34 percent. Cross-resistance to nalidixic acid and ciprofloxacin was found in 33.3 percent of human samples and 11.8 percent of animal samples. Human samples could not be typed using the Penner method. F serotype was the most expressed in poultry. We obtained a total of 14 genotypes (4 / 5 human and 10/15 avian). In conclusion, the predominant species in poultry and humans was C. jejuni, a significant amount of quinolone-resistant human and avian samples were obtained, and avian genotypes and serotypes were not found in human samples. The latter would mean that another source of infection could exist; therefore other reservoirs must be studied.

Las aves de consumo constituyen uno de los principales reservorios y fuente de infección humana de la campilo-bacteriosis. Se analizaron 341 muestras de deposiciones, 291 humanas y 50 aviares. De las muestras, 220 de niños con síndrome diarreico agudo-SDA (183 hospitalizados y 37 consultantes ambulatorios) y 71 niños sanos. A las 23 cepas obtenidas se les realizó CIM por dilución en agar a eritromicina y ciprofloxacina, serotipificación de Penner y genotipiicación por RAPD-PCR. Se encontró Campylobacterjejuni sólo en pacientes con SDA, de ellos 5,4 por ciento ambulatorios y 2,2 por ciento hospitalizados. En aves, la prevalencia de Campylobacter spp., fue de 34 por ciento. Hubo resistencia cruzada a ácido nalidixico y ciprofloxacina en 33,3 por ciento cepas de origen humano y 11,8 por ciento animal. Las cepas humanas fueron no tipiicables por el método de Penner. Predominó entre las aves el serotipo F. Se obtuvo un total de 14 genotipos (4/5 humanos y 10/15 aviares). En conclusión, la especie predominante en aves de corral y en humanos fue C. jejuni, existiendo una alta prevalencia de cepas de origen humano y aviar resistentes a quinolonas. Los genotipos y serotipos aviares no fueron encontrados en cepas de origen humano, lo que indica que podría existir otra fuente de infección, por lo que se requiere estudiar otros reservorios.

Ontogeny and structure of the acervulate partial inflorescence in Hyophorbe lagenicaulis (Arecaceae; Arecoideae).

BACKGROUND AND AIMS: The palm tribe Chamaedoreeae displays flowers arranged in a complex partial inflorescence called an acervulus. This type of partial inflorescence has so far not been reported elsewhere in the largest palm subfamily Arecoideae, which is traditionally characterized by flowers predominantly arranged in triads of one central female and two lateral male flowers. The ontogenetic basis of the acervulus is as yet unknown and its structural diversity throughout the genera of the Chamaedoreeae poorly recorded. This study aims to provide critical information on these aspects. METHODS: Developmental series and mature inflorescences were sampled from plants cultivated in international botanical gardens and wild populations. The main techniques employed included scanning electronic microscopy and serial anatomical sectioning of resin-embedded fragments of rachillae. KEY RESULTS: Inflorescence ontogeny in Hyophorbe lagenicaulis demonstrates that the acervulus and the inflorescence rachilla form a condensed and cymose branching system resembling a coenosome. Syndesmy results from a combined process of rapid development and adnation, without or with reduced axis elongation. Acervulus diversity in the ten taxa of the Chamaedoreeae studied is displayed at the level of their positioning within the inflorescence, their arrangement, the number of floral buds and their sexual expression. CONCLUSIONS: The results show that a more general definition of the type of partial inflorescence observed within the large subfamily Arecoideae would correspond to a cyme rather than to a floral triad. In spite of their common cymose architecture, the floral triad and the acervulus present differences with respect to the number and arrangement of floral buds, the superficial pattern of development and sexual expression.

[Genotyping and antibacterial resistance of Campylobacter spp strains isolated in children and in free range poultry]. / Genotipificación y resistencia antibacteriana de cepas de Campylobacter spp aisladas en niños y en aves de corral.

Poultry is a main reservoir and source of human infection in campylobacteriosis. Three hundred and forty one stool samples (291 human, 50 avian) were analyzed. In the human group, 220 samples were collected from children with acute diarrheal disease (183 inpatients, 37 outpatients) and 71 from healthy children. Erythromycin and ciprofloxacin agar dilution MIC tests, Penner serotyping and RAPD-PCR genotyping were performed on 23 strains isolated. C. jejuni was reported only in patients with acute diarrhea (5.4% inpatients, 2.2% outpatients). Campylobacter prevalence in poultry was 34%. Cross-resistance to nalidixic acid and ciprofloxacin was found in 33.3% of human samples and 11.8% of animal samples. Human samples could not be typed using the Penner method. F serotype was the most expressed in poultry. We obtained a total of 14 genotypes (4 / 5 human and 10/15 avian). In conclusion, the predominant species in poultry and humans was C. jejuni, a significant amount of quinolone-resistant human and avian samples were obtained, and avian genotypes and serotypes were not found in human samples. The latter would mean that another source of infection could exist; therefore other reservoirs must be studied.

[Descriptive analysis about a group of patients with recurrent acute pancreatitis]. / Análisis descriptivo de un grupo de enfermos con pancreatitis aguda recidivante.

BACKGROUND: Recurrent acute pancreatitis (RAP) represents a diagnostic and treatment challenge. Although it's real frequency is difficult to establish some works have reported 25-60% prevalence. In most, the etiology is recurrent biliary stones untreated or consumption of alcohol. The information we have about the RAP in our midst is scarce. AIM: To review the clinical characteristics and follow-up of a group of patients with RAP. METHODS: Clinical charts of all patients with AP admitted to our Institute from January 1, 1995 to December 31, 2005 were reviewed. The diagnosis of RAP was established when two o more episodes of AP were documented. In each case clinical, biochemical, imaging, treatment and follow-up until the last visit to our hospital was analyzed. RESULTS: The diagnosis of AP was established in 406 patients. Forty of them had RAP (9.8%). Mean age was 32 years old (13-63). The majority was male (72.5%). A mean of 3.5 episodes of AP was presented for each subject (2-14). High levels of triglycerides (n = 15), alcoholism (n = 11) and gallstones (n = 8) were the most frequent cause of RAP. In some cases more than one factor was presented. In 5 of the 15 subjects with RAP due to hypertriglyceridemia other causes of AP were identified (two alcohol consumption,two idiopathic chronic pancreatitis and one gallstone disease). In three patients with RAP supposedly secondary to alcohol, gallstone disease was diagnosed during the follow-up. All of them were operated on. One has had four events of AP after the cholecistectomy. Four of the 8 subjects submitted to cholecistectomy for RAP associated to gallstone disease have had new episodes of AP: 2 for triglycerides and in two a chronic pancreatitis was diagnosed by endoscopic ultrasound or MRI. Two patients died (5%). CONCLUSIONS: This series represents probably the first analysis that exists on PAR in Mexico. The frequency found was 9% and the most common causes were hypertriglyceridemia, chronic alcohol consumption and gallstones.

The botánica as a culturally appropriate health care option for Latinos.

OBJECTIVES: The purpose of this study was to make a preliminary assessment of the botánica as a culturally appropriate health care option for Latinos in the United States. DESIGN AND SUBJECTS: Closed-ended interviews were carried out using a questionnaire with 26 customers of a botánica located in a primarily urban Mexican American community in the United States. RESULTS: Sample gender was predominantly female with an average age of 38 years and income in the range of $15,000-$29,999 per year. Most participants were married (16), had children (17), and most (22) had formal education. Products purchased at the botánica included herbs, religious amulets, and other products. Although botánicas are commonly believed to provide remedies only for folk illnesses, the participants in this study reported seeking remedies primarily for somatic illnesses. CONCLUSIONS: The respondents used the services of conventional health care providers interchangeably with the botánica, making the botánica an important health care resource for Latinos in the United States. Further research should be carried out to better understand the role of botánicas in health care delivery.

Pregnancy discovery and acceptance among low-income primiparous women: a multicultural exploration.

OBJECTIVES: As part of a larger study exploring psychosocial factors that influence self-care and use of health care services during pregnancy, we investigated the process of pregnancy discovery and acceptance among a culturally diverse group of women who had given birth to their first child in the year preceding data collection. METHODS: Eighty-seven low-income women from four cultural groups (African American, Mexican, Puerto Rican, and white) participated in eight focus groups held in their communities. The focus groups were ethnically homogenous and stratified by early and late entry into prenatal care. A social influence model guided the development of focus group questions, and the study followed a participatory action research model, with community members involved in all phases of the research. RESULTS: Issues that emerged from the focus groups as possible influences on timing of pregnancy recognition include the role of pregnancy signs and symptoms and pregnancy risk perception in the discovery process, the role of social network members in labeling and affirming the pregnancy, concerns about disclosure, "planning" status of the pregnancy, and perceived availability of choices for resolving an unintended pregnancy. CONCLUSIONS: The pregnancy discovery process is complex, and when protracted, can potentially result in delayed initiation of both prenatal care and healthful pregnancy behaviors. Enhancing our understanding of pregnancy discovery and acceptance has clear implications for primary and secondary prevention. Future research is needed to further explain the trajectory of pregnancy discovery and acceptance and its influence on health behaviors and pregnancy outcome.

Use of herbal therapies among midlife Mexican women.

The cultural traditions of Mexican women living in the United States make it likely that some women promote their health and manage their symptoms using various herbal therapies, yet we know little about this phenomenon. The purpose of this study was to describe and compare midlife Mexican women living in the U.S. who were or were not using herbal therapies with regard to the extent of their acculturation, beliefs about herbs, and factors associated with their utilization of health services. A convenience sample of 30 Mexican women between the ages of 40 and 56 years completed face-to-face interviews in either English or Spanish. Nearly half reported using herbal therapies. With the exception of positive beliefs about herbs, we found few differences between herbal users and nonusers on acculturation or access to, and satisfaction with, health services. Although acculturation did not appear to influence whether the women used herbal therapies, it did relate to the types of herbs selected. Women most commonly reported using herbs popular in traditional Mexican culture, including manzanilla (chamomile), savila (aloe vera), ajo (garlic), uña de gato (cat's claw), and yerba buena (spearmint).

Improving question wording in surveys of culturally diverse populations.

PURPOSE: The purpose of this paper is to briefly describe a theoretical model articulating cognitive theory and sources of potential response bias resulting from racial or ethnic cultural experience to survey questions that deal with health behavior. The theory components are then evaluated using questions obtained from national health surveys conducted by the National Center for Health Statistics and Centers for Disease Control and Prevention. The analysis explores the effects of four cognitive tasks involved in responding to questions as specified by the model: question interpretation, information retrieval from memory, judgment formation, and response editing. Implications for epidemiological research are considered. METHODS: Data were collected from a purposive sample of 423 adults aged 18 through 50 who were recruited to ensure equal numbers of African American, Puerto Rican, Mexican American, and non-Hispanic white respondents, stratified by age, gender, and education. Individual questions were selected for evaluation to ensure variation by topic and question format. Probes related to each of the cognitive tasks were designed to obtain insight into the underlying cognitive processes used by respondents to answer survey questions. All statistical analyses used logistic regression or ordinary least squares multiple regression as appropriate. RESULTS: Variation by race/ethnicity was found in the way respondents defined physical activity in a series of questions used in the Centers for Disease Control and Prevention Behavioral Risk Factor Surveillance System (BRFSS). Gender and race/ethnicity appeared to influence interpretation in the absence of specific cues in the question format about how to respond. Strategies used to retrieve information from memory did not appear to be influenced by respondent culture; however, frequency of the event was associated with the recall strategy in that more frequent or regular events were more likely to result in estimates about frequency, whereas unusual or seldom occurring events were counted. Effects of race/ethnicity on judgment formation seem to be reflected in the propensity of respondents' willingness to use extreme response categories. Most effects due to race/ethnicity were found in respondent editing of answers. Race/ethnicity was found to be associated with a social desirability trait; with willingness to disclose socially undesirable behavior, particularly to interviews from racial or ethnic groups that differed from the respondent; and with the tendency to overreport socially desirable behavior. CONCLUSIONS: Overall, the results of this research suggest several ways in which the validity of questions about risk behavior can be improved. In designing such questions, the investigator should envision the interview as a structured conversation in which ordinary conversational norms apply. Thus, questions that might request redundant information or that are threatening to the respondent need to be asked in ways that minimize these effects. Using interviewers of the same racial or ethnic group is important. Attending to the order of questions to ensure that redundant information is not requested is important. Writing questions to ensure that where response cues occur they lead the respondent to answer in unbiased ways is also important. Testing questions for potential racial or ethnic bias before using them is also important, even if the questions have been used successfully with population groups other than that or those included in a study.

Dietary vitamin C, beta-carotene and 30-year risk of stroke: results from the Western Electric Study.

The relations of dietary antioxidants vitamin C and beta-carotene to 30-year risk of stroke incidence and mortality were investigated prospectively in the Chicago Western Electric Study among 1,843 middle-aged men who remained free of cardiovascular disease through their second examination. Stroke mortality was ascertained from death certificates, and nonfatal stroke from records of the Health Care Financing Administration. During 46, 102 person-years of follow-up, 222 strokes occurred; 76 of them were fatal. After adjustment for age, systolic blood pressure, cigarette smoking, body mass index, serum cholesterol, total energy intake, alcohol consumption, and diabetes, relative risks (and 95% confidence intervals) for nonfatal and fatal strokes (n = 222) in highest versus lowest quartiles of dietary beta-carotene and vitamin C intake were 0.84 (0.57-1.24) and 0.71 (0.47-1.05), respectively. Generally similar results were observed for fatal strokes (n = 76). Although there was a modest decrease in risk of stroke with higher intake of beta-carotene and vitamin-C intake, these data do not provide definitive evidence that high intake of antioxidant vitamins decreases risk of stroke.

Involving parents in cancer risk reduction: a program for Hispanic American families.

The authors explored changes in dietary behavior, nutrition knowledge, and parental support among inner-city, low-income, Hispanic American families. Thirty-eight families were randomly assigned to receive a 12-week, culture-specific dietary intervention or be in a control group. Results showed that parental support was related to changes in diet, nutrition knowledge, and attendance for both mothers and children. Dietary behavior changes (e.g., reduction in dietary fat) were seen only in the treatment group. Distribution of health-related pamphlets to the control group may have promoted cognitive changes (e.g., increased nutrition knowledge) seen in this low-literacy sample. Further research is needed to document behavioral changes after ethnic-specific interventions and the maintenance of those changes over time.

Dietary beta-carotene, vitamin C, and risk of prostate cancer: results from the Western Electric Study.

Dietary factors are likely candidates for important determinants of prostatic cancer risk. Among the most investigated nutritional factors have been antioxidants. We evaluated dietary beta-carotene and vitamin C in relation to subsequent risk of prostate cancer in a prospective study of 1,899 middle-aged men. We combined prostate cancer cases diagnosed in the first 24 years of follow-up with incident cases identified from the Health Care Financing Administration hospitalization and outpatient files during an additional 6-year follow-up period. We obtained death certificates for all decedents. During the 30-year follow-up, prostate cancer developed in 132 men. There was no indication that consumption of beta-carotene or vitamin C was related to increased or decreased risk of prostate cancer. Relative risks for highest vs lowest quartiles of beta-carotene and vitamin C intake were 1.27 [95% confidence interval (CI) = 0.75-2.14] and 1.03 (95% CI = 0.59-1.60), respectively, after adjustment for age, number of cigarettes smoked per day, dietary cholesterol and saturated fat, alcohol consumption, total energy intake, and occupation. Associations between intake of these nutrients and risk of prostate cancer differed depending on whether the cancer was diagnosed during the first 19 years of follow-up or the next 11 years of follow-up. Overall survival over the 30 years of follow-up was positively associated with intake of beta-carotene and vitamin C.

A brief, telephone-administered food frequency questionnaire can be useful for surveillance of dietary fat intakes.

A 13-item questionnaire designed for quick telephone administration was evaluated for use in surveillance of fat intake in the United States. Study populations included 560 middle-aged and older adults from Beaver Dam, WI, 252 middle-aged and older women from Wisconsin, 73 young, low income Hispanic women from Chicago, IL, 52 older adults from Arizona and 135 younger adults from Augusta, GA. Correlations between fat scores and fat intakes measured by multiple food records or recalls or by more extensive food frequency questionnaires ranged from 0.33 to 0.60, similar to results from other published questionnaire validation studies. Correlations with percentage of energy from fat were lower (0.26 to 0.42), except for the Chicago population, for which there was no correlation (-0.02). There was no systematic variation in correlations among other subgroups defined by demographic and health-related characteristics, including race (black vs. white). Most, but not all, of the substantial differences in fat intakes among subgroups were identified by the questionnaire. The questionnaire will not capture small differences in intakes among groups and is inappropriate when the sample size is limited or for populations with diets substantially different from the typical U.S. diets, such as the Chicago population. However, with attention to its limitations, the questionnaire is useful for surveillance.

Nutritional status of Northwest Indiana Hispanics in a congregate meal program.

Rapid growth in the Hispanic elderly population, coupled with their unique needs, necessitates increasing their numbers in Title III(C) meal programs. This study assessed the nutritional adequacy of the diets of 49 Northwest Indiana congregate meal participants by evaluating: (1) their 1-day food records, and (2) the contributions of the site meal to daily intake. Mean daily total nutrient intakes, except for energy intake by the men, exceeded 67% of the Recommended Dietary Allowances (RDAs); however, only 22% of individual diets met this standard. Mean site meal nutrient intakes, aside from energy and magnesium by men, exceeded the recommended one-third of the RDAs, and contributed 42-73% of most nutrients to the daily intake despite the fact that the majority of the recipients refused one or more offered site meal components. Results of this study verify the importance of the role of congregate meals in providing nutritional adequacy to diets of Hispanic elderly and can be useful in menu and program planning for this population.

Evaluation of a brief telephone questionnaire to estimate fruit and vegetable consumption in diverse study populations.

We evaluated the use of a six-item telephone questionnaire to estimate fruit and vegetable intakes in five diverse populations. Researchers administered the telephone questionnaire to persons who had previously undergone more extensive dietary assessment. The study population included 553 middle-aged and older adults in Beaver Dam, WI; 252 middle-aged and older women throughout Wisconsin; 150 parents of school children in Augusta, GA; 73 low-income, Hispanic mothers in Chicago, IL; and 51 older adults in Arizona. Spearman correlation coefficients between total fruit and vegetable intakes measured by the brief telephone survey and by more extensive food frequency questionnaires were 0.47 (Augusta), 0.48 (Arizona), 0.56 (Wisconsin), and 0.57 (Beaver Dam). Correlations between intakes measured by the brief telephone survey and by multiple diet records or recalls were 0.29 (Arizona), 0.46 (Chicago), and 0.54 (Beaver Dam). With the exception of Arizona, mean daily fruit and vegetable intakes measured by the telephone survey were similar to intakes estimated by multiple diet records or recalls and lower than those estimated by extensive food frequency questionnaires. Although caution may be needed in interpreting dietary reports from some ethnic subgroups, this brief telephone questionnaire may be useful for surveillance of fruit and vegetable intake in the United States.