Diné Navajo Resilience to the COVID-19 pandemic.

OBJECTIVE: To date, there are no studies of COVID-19 cases and deaths in the Navajo Nation, US. The primary objective of this manuscript is to understand whether counties with a higher proportion of Navajo (Diné) population also had higher cases and deaths of COVID-19 and whether these dropped with vaccination. METHOD: We undertook a cross-sectional analysis of county level data from March 16, 2020-May 11, 2021. Data were obtained from public repositories and the US Census for the Navajo Nation, including northeastern Arizona, southeastern Utah, and northwestern New Mexico. The primary outcome measure is the number of individuals with confirmed cases or deaths of COVID-19. A secondary outcome was COVID-19 vaccinations. RESULTS: The 11 counties in Navajo Nation have a wide variation in the percent Navajo population, the resources available (ICU beds and occupancy), and COVID-19 outcomes. Overall, there was a substantial increase in the number of cases from March 16 -July 16, 2020 (the height of the pandemic) with a doubling time of 10.12 days on Navajo Nation. The percent Navajo population was a strong predictor of COVID-19 cases and deaths per million population. COVID-19 vaccinations were inversely associated with COVID-19 cases and deaths in these counties. CONCLUSIONS: The COVID-19 pandemic on the Navajo Nation is a story of resilience. Navajo Nation was one of the hardest hit areas of the United States, with peak cases and deaths due to COVID-19. With an aggressive vaccination effort, these cases and deaths were strikingly curtailed, showing the resilience of the Navajo (Diné) people.

Traditional Healers as Health Care Providers for the Latine Community in the United States, a Systematic Review.

Background: Due to structural barriers to accessing the biomedical health care system, traditional healers (THs) often serve as the first point of contact for health care by Latine individuals in the United States. A recent assessment of the extent of use of THs by the Latine community is lacking. Methods: We conducted a systematic review of the literature published between 2000 and 2020, to assess the prevalence of use of THs by U.S. Latine individuals, health conditions for which care was sought, reasons for their use, and extent of TH use and dual use that is of biomedical health care and TH together. Primary inclusion criteria for studies included: (1) published in English, (2) focus on THs, (3) pertained to Latine individuals residing in the United States, and (4) published since 2000. Results: Eighty-five studies were reviewed; 33 met inclusion criteria. Under the overarching term of curanderos, 4 subtypes of THs were identified: sobadores, yerberos, espiritualistas, and hueseros. The lifetime prevalence of TH use varied from 6% to 67.7% depending on the demographic differences among the Latine individuals in these studies. Primary reasons for seeking care from THs were accessibility/convenience, affordability, and linguistic and cultural congruence. Discussion: The use of THs is highly prevalent for Latine community residing in the United States because they are accessible, affordable, and provide culturally and linguistically compatible care, indicating that they offer an alternative that addresses systemic structural barriers to biomedical health care. Further research on the efficacy and safety of the treatments rendered by THs and how their care might be optimally coordinated with biomedical health care, could improve health equity and access to care among Latine individuals in the United States.

Psychosocial functioning and physical symptoms in heart failure patients: a within-individual approach.

OBJECTIVE: Heart failure (HF) markedly diminishes an individual's quality of life. However, little is known about how psychosocial functioning is related to heart failure physical symptom expression (e.g., chest pain or heaviness, shortness of breath) on a day-to-day basis. METHODS: Fifty-eight HF patients completed daily diaries that evaluated mood, social support, coping, and physical symptoms for 2 weeks. RESULTS: After being prewhitened for serial dependencies, the data were entered into regression analyses to determine the concurrent and lagged relationships among them. Significant concurrent relationships were obtained between physical symptoms and depression, social conflict, positive and negative mood, and symptom-focused coping. Furthermore, negative mood and distraction coping predicted greater physical symptoms the next day, while action/acceptance coping predicted fewer physical symptoms the next day. CONCLUSION: Our data provide evidence for an association between daily psychosocial functioning and HF physical symptoms. Implications for research and clinical work with HF patients are discussed.

Mg citrate found more bioavailable than other Mg preparations in a randomised, double-blind study.

Published data on the bioavailability of various Mg preparations is too fragmented and scanty to inform proper choice of Mg preparation for clinical studies. In this study, the relative bioavailability of three preparations of Mg (amino-acid chelate, citrate and oxide) were compared at a daily dose of 300 mg of elemental Mg in 46 healthy individuals. The study was a randomised, double-blind, placebo-controlled, parallel intervention, of 60 days duration. Urine, blood and saliva samples were taken at baseline, 24 h after the first Mg supplement was taken ('acute' supplementation) and after 60 days of daily Mg consumption ('chronic' supplementation). Results showed that supplementation of the organic forms of Mg (citrate and amino-acid chelate) showed greater absorption (P = 0.033) at 60 days than MgO, as assessed by the 24-h urinary Mg excretion. Mg citrate led to the greatest mean serum Mg concentration compared with other treatments following both acute (P = 0.026) and chronic (P = 0.006) supplementation. Furthermore, although mean erythrocyte Mg concentration showed no differences among groups, chronic Mg citrate supplementation resulted in the greatest (P = 0.027) mean salivary Mg concentration compared with all other treatments. Mg oxide supplementation resulted in no differences compared to placebo. We conclude that a daily supplementation with Mg citrate shows superior bioavailability after 60 days of treatment when compared with other treatments studied.

The association between emotional upset and cardiac arrhythmia during daily life.

Ventricular arrhythmia exhibits considerable within-subject variability that cannot be attributed to clinical status alone. This investigation examined the extent to which cardiac arrhythmia was associated with psychological and physical factors assessed during the hour preceding arrhythmic or nonarrhythmic activity. Approximately twice hourly, 46 patients randomly completed a diary assessing mood and physical symptoms during 24-hr electrocardiographic monitoring. Greater negative emotion was associated with increased arrhythmia. Additionally, greater negative emotion was significantly associated with increased arrhythmia among participants in a low left ventricular ejection fraction group (LVEF). However, this relationship between negative emotion and arrhythmia was not observed among higher LVEF participants. These findings contribute to a larger body of evidence suggesting that negative moods may exacerbate cardiac conditions.