Beneficial Effect of Remote Glucose Monitoring and Computerized Insulin Dose Adjustment Algorithms Independent of Insulin Dose Increases in Sizeable Minorities of Patients.

This article describes a program through which interactions every 2-3 weeks between patients and primary care clinicians (PCCs), with recommendations based on analysis of remote glucose monitoring by computerized insulin dose adjustment algorithms, significantly improved diabetes control. Insulin doses increased by 30% in the majority of patients. A sizeable minority (36%) had a decrease or no increase in insulin doses, but still showed an improvement in diabetes control. Frequent interactions allowed PCCs the opportunity to recognize and address medication nonadherence.

The Impact of Sibling Relationships on Behavioral and Sexual Health among Latino Sexual Minority Men.

Pre-exposure prophylaxis (PrEP) is a highly effective method for preventing HIV acquisition and plays a crucial role in the Ending the HIV Epidemic in the US initiative. However, there are various barriers that hinder the access and uptake of PrEP among Latino sexual minority men (SMM) at individual, interpersonal, and cultural levels. While the significance of cultural factors in designing and implementing HIV prevention programs for Latino populations has been consistently emphasized in the literature and prioritized by the Centers for Disease Control and Prevention, few studies have directly integrated these cultural factors into their programs. Our study aimed to investigate the potential influence of siblings in promoting the utilization of PrEP for HIV prevention, an area that has received limited attention. We conducted interviews with 31 pairs of siblings between December 2020 and January 2021, which were held in either English or Spanish and lasted approximately 45-60 min. The data were analyzed using a deductive thematic content analysis approach. The interviews revealed several key themes and categories, including: (1) Sibling support for coming out; (2) Types of support that siblings provide to each other for behavior change; (3) Sibling support for PrEP; and (4) The impact of the study interview on the quality of the sibling relationships. Our findings indicated that siblings were willing to provide support for PrEP in various ways, ranging from emotional support for brothers who may be concerned about potential rejection to practical support such as transportation or financial assistance. These results have significant implications for the design of HIV prevention interventions for Latinos. Incorporating siblings or other extended family members into these interventions can facilitate communication between siblings and their brothers, ultimately encouraging the use of PrEP or similar prevention methods. By considering the unique dynamics and support systems within Latino communities, researchers can develop more effective strategies to promote HIV prevention and support the well-being of Latino SMM.

Would the Siblings of Latinx Men Who Have Sex With Men Encourage Their Brothers to Use PrEP? Findings From a Feasibility and Acceptability Study.

We explored whether siblings can be engaged in PrEP promotion. We used the Information-Motivation-Behavior model to develop and conduct surveys and dyadic interviews with Latino men who have sex with men (LMSM) and their siblings (n = 31) and three sibling-only focus groups (n = 20). For LMSM, only n = 14 (45%) agreed they would benefit from taking PrEP, yet n = 22 (71%) would take PrEP to make their sibling worry less about them, and n = 23 (74%) requested a PrEP referral. For siblings, n = 20 (65%) believed PrEP would benefit their brother, and n = 19 (95%) in the focus groups said they would take PrEP to help their brother get started. Qualitative results include (1) siblings' support for PrEP use, (2) explicit conversations about sex were not necessary for discussing sexual health, and (3) siblings wanted to understand what they could do to encourage their brother to consider PrEP. We conclude siblings can be engaged in PrEP promotion.

Effectiveness of Clinic-Based Brief Behavioral Intervention (BBI) in Long-term Reduction of ADHD Symptoms Among Preschoolers.

Preschoolers commonly experience symptoms of ADHD and disruptive behavior problems. Behavioral parent management training (PMT) is an evidence-based intervention for addressing both ADHD and disruptive behaviors in this population; however, many PMT programs are burdensome in length and have limited data regarding long-term effectiveness for ADHD specific outcomes. This study examined outcomes up to 1 year following completion of a brief behavioral intervention (M = 6.51 sessions) for preschoolers. Participants were children aged 2-6 years with clinically significant disruptive behaviors and their parents. Results demonstrated significant improvements in parent-reported child hyperactivity and inattention from pre-to-post intervention, with sustained improvement at 6 months and 1 year post intervention. Teacher-reported hyperactivity and inattention also showed significant improvements from pre-to-post intervention, which were maintained across time points. These results were also found among a subset of participants with clinically significant ADHD symptoms at baseline. This study highlights the long-term effectiveness of a brief PMT program to address symptoms of ADHD and disruptive behaviors in preschoolers. Findings support the recommendation to offer PMT as a first-line intervention for preschoolers with ADHD symptoms to reduce the need for early intervention with stimulant medication and address comorbid disruptive behaviors.

Implementing texting programs in the P.O.W.E.R. (preventing obesity with eating right) medical group visit for weight loss.

BACKGROUND: The effect of incorporating mobile technology to support participants' lifestyle change and weight loss in medical group visits has not been well studied in a safety-net setting. RATIONALE AND DESIGN: Thus, the rationale of the current study was to examine the effect of text messaging in a medical group visit, and test the effect of two texting programs (12 weeks and 20 weeks), compared to those who did not receive text-messaging in the Preventing Obesity With Eating Right (POWER) group visit program. The primary outcome was weight loss. RESULTS: We found that those enrolled in the 20-week and 12-week texting programs attended more group visit sessions than those enrolled in the POWER group only (p < 0.001). Both POWER and POWER + 20-week texting groups had a significant reduction in weight at their final group visit compared to their baseline (POWER, 114 ± 27 kg vs. 112 ± 26 kg, p < 0.001; POWER + 20-week texting, 111 ± 28 kg vs. 109 ± 28 kg, p < 0.01), but not the 12-week texting group (114 ± 29 kg vs. 113 ± 29 kg, p = 0.22), with no differences between the groups. The number of group visits was correlated with a decrease in weight (rs  = 0.12, p < 0.05). CONCLUSION: In conclusion, text messaging programs led to more attendance in the medical group visits, but not greater weight loss or reduction in HbA1c than the POWER group obesity program alone. Further studies are needed to maximize the beneficial effects of texting programs in medical group visits in underserved minority populations.

Miastenia gravis de rápida instauración / Fast onset Myasthenia Gravis

La miastenia gravis es una enfermedad que se caracteriza por fatiga y debilidad muscular de predominio proximal, como son los músculos oculares, funciones bulbares, de las extremidades y de los músculos respiratorios. La evolución de la enfermedad suele ser fluctuante. Es la alteración más común dentro de las enfermedades que afectan a la transmisión neuromuscular. Los síntomas derivan de la agresión inmunológica contra la membrana postsináptica de la unión neuromuscular. Presentamos el caso de un hombre de 36 años que acude a consulta por parestesias al comer, que ceden espontáneamente a los pocos minutos. Dos semanas después es ingresado por diplopía y disfagia. Tras la sospecha de miastenia gravis, se realizan las pruebas complementarias pertinentes, concluyendo en el diagnóstico de miastenia gravis generalizada seronegativa asociada a timoma.(AU)

Myasthenia gravis is a disease characterised by mainly proximal muscle fatigue and weakness. For example, the eye muscles, bulbar function, limb and respiratory muscles. Clinical course of the disease is usually variable. This is the most common abnormality within diseases that affect neuromuscular transmission. Symptoms arise from immunological aggression against the postsynaptic membrane of the neuromuscular junction. We report the case of a 36-year-old man who consulted for paraesthesia whilst eating, which went away spontaneously after a few minutes. Two weeks later he was admitted for diplopia and dysphagia. After suspecting myasthenia gravis the relevant additional tests were performed, which led to a diagnosis of seronegative generalised myasthenia associated with thymoma.(AU)

Short report: sticks and stones may break my bones, but words can also hurt me: understanding language interpreters' perceptions of stress/growth and needs in a pediatric medical setting.

An increased focus on quality, trauma-informed patient care also warrants examination of providers' experiences of stress in medical settings. However, little is known about language interpreters' experiences of stress in the pediatric hospital setting, despite their involvement in acute and difficult patient encounters. This pilot study evaluated language interpreters' experiences and perceptions of stress in a large children's hospital. Descriptive and qualitative analyses, using a novel survey measure of interpreters' experiences, were performed to evaluate language interpreters' experiences with stressful patient encounters and identification of available and desired supports. All interpreters surveyed endorsed experiencing stress during challenging patient encounters in the hospital, though the majority also identified positive changes to their worldview as a result of their work. Results highlighted interpreters' strategies to cope with stress and perceived institutional needs to manage stressful encounters. Interpreters' experiences of stress in the pediatric hospital underscores needs for prevention and intervention efforts aimed at helping interpreters manage job-related stress. Preliminary, trauma-informed recommendations for working with and supporting interpreters are proposed.

Friend Support and the Parenting of Latina Adolescent Mothers: The Moderating Role of Maternal Age.

OBJECTIVES: This study examined the role of maternal age in the relation between social support from friends and parenting adjustment in a sample of young Latina mothers and their 18-month-old children (N=168). METHODS: Hierarchical multiple regression analyses tested friend social support types (emotional, socializing, child care) as differential predictors of maternal behavior (sensitivity, cognitive growth-fostering, detachment) displayed during mother-child play interactions. To consider maternal development, the moderating role of maternal age on these associations was tested. RESULTS: The relations between friend emotional and child care support and parenting were moderated by maternal age. Emotional support was related to the use of more growth-fostering parenting behaviors for older (≥ 19.5 yrs.), but not for younger Latina mothers. Child care support from friends was related to the display of more detachment and less cognitive growth-fostering behaviors among the younger (≤ 18.7 yrs.) mothers only. Immigrant mothers reported significantly less overall friend support and emotional support than mothers born in the mainland U.S. CONCLUSIONS: The findings emphasize the importance of assessing the types of friend support as separate measures in an ecological context that takes into account mothers' generational and developmental level.

Cancer-related Knowledge, Attitudes and Behaviors within the Latino Faith Community in South Los Angeles.

Objectives: The goal of this study was to establish relationships with Latino churches in South Los Angeles and to collect data from parishioners regarding their access to care, cancer risk factors, and cancer-related knowledge, attitudes and screening. Methods: In 2014, we approached five Latino churches. All allowed us to describe the study and to consent potential respondents at a designated time during the church service. Results: 398 Latino respondents (75% female) completed the survey in English (15%) or Spanish (85%). Most respondents were born in Mexico (63%). Only 56% had health insurance and 51% had a regular doctor. Based on self-reported height and weight, 33% were overweight and 51% were obese. However, only 42% of obese respondents had been told by their doctor that they were obese. Although it is well-established that obesity is a major cancer risk factor, respondents lacked knowledge about the important role of nutrition and exercise in cancer prevention. Among women, adherence to national screening guidelines was 88% for cervical cancer, 72% for breast cancer and 58% for colorectal cancer. However, they were quite willing to undergo cancer screening if recommended by a physician and reported few barriers to colorectal cancer screening. Conclusions: Our data suggest a need to focus on both primary and secondary cancer prevention by promoting healthy lifestyles to curb the obesity epidemic and by promoting colorectal cancer screening. These data will inform future interventions to promote wellness in South Los Angeles in collaboration with the Latino faith community.

Scratching Below the Surface: Screening for Posttraumatic Stress Symptoms Following Hospitalization With the Pediatric Trauma Service.

Significant progress has occurred medically for children who have experienced traumatic injuries; however, attention to their psychological adjustment has only more recently been a focus in research and clinical practice. These needs do not cease at discharge but, instead, require monitoring to determine whether further assessment and/or intervention are required. Our team, inclusive of the Psychology Service and the Trauma Service, identified 2 established screening measures (based on age) that were completed by patients during their outpatient follow-up visits postdischarge. Should a patient screen positive, the Trauma Service referred them to the Psychology Service for further evaluation and possible treatment (i.e., trauma-focused cognitive-behavioral therapy). Of 881 trauma activations, 31 (4%) patients were screened at an outpatient follow-up appointment through pediatric surgery/trauma clinic. Of these completed screening tools, 29% screened positive and warranted a referral to Psychology. Intervention was recommended for the majority of the patients evaluated; however, half of these did not return for this intervention. A collaboration between the Psychology Service and the Trauma Service is a vital step toward providing stepped care for patients after unintentional injuries. This allows for evaluation of patient needs and then a referral source to meet these identified needs. Future directions include increasing the number of screened patients, perhaps with use of technological supports (i.e., REDCap) or expansion into other clinics and consideration of ways to increase family's use of psychological intervention. LEVEL OF EVIDENCE: Therapeutic/Care management Level IV.

Comparison of Insulin Dose Adjustments by Primary Care Physicians and Endocrinologists.

IN BRIEF Insulin dose adjustment decisions in 20 simulated patients by nine primary care physicians (PCPs) and nine endocrinologists were compared to the algorithms used in a diabetes program in a large safety-net clinic. The number of dose changes was similar in the PCP and endocrinologist groups; however, the amounts of the dose changes in the PCP group were significantly closer to the diabetes program algorithms than the amounts in the endocrinologist group. Time constraints, rather than lack of ability, seem to be the major barrier to PCPs treating patients with insulin.

Polimialgia y arteritis de células gigantes en un matrimonio / Polymyalgia and giant-cell arteritis in a married couple

Pareja conviviente de más de 40 años en la que, en breve espacio de tiempo, la mujer es diagnosticada de arteritis de células gigantes y el esposo de polimialgia reumática (AU)

Couple cohabiting for over 40 years in which, in a short space of time, the wife is diagnosed with giant-cell arteritis and the husband with polymyalgia rheumatica (AU)

Psychological Adjustment among Young Puerto Rican Mothers: Perceived Partner Support and the Moderating Role of Latino Cultural Orientation.

Adolescent mothers face multiple stressors and are at risk for experiencing high levels of depressive symptoms and parenting stress. This study examined the interplay of Latino cultural orientation and perceived support from romantic partners in protecting the adjustment of young, low-income, Puerto Rican mothers (N = 103; M age = 18.0 yrs; SD = 1.2) during the second year postpartum. In multivariate analyses, perceived partner support was uniquely and negatively associated with both maternal depressive symptoms and parenting stress. However, in the case of parenting stress, this association was moderated by mothers' Latino cultural orientation. Perceived partner support was related to less parenting stress when mothers endorsed a relatively strong Latino cultural orientation; perceived partner support was no longer protective at low levels of Latino orientation. The implications for intervention and for the understanding of the role of culture in social support processes within close relationships are discussed.

Ideas autolíticas secundarias a gabapentina / Autolytic ideation secondary to gabapentin

Se trata de una paciente tratada con dosis altas de gabapentina por una estenosis de canal lumbar cuyo efecto incluyeron ideas autolíticas y alucinaciones auditivas. Suspendido el tratamiento desaparece la sintomatología y no vuelve a recidivar (AU)

We report the case of a female patient administered high doses of gabapentin due to a lumbar spinal stenosis. As an effect, she presented autolytic ideation and auditory hallucinations. After stopping the treatment, symptoms disappear without recurrence (AU)

The influence of cultural orientation on associations between Puerto Rican adolescent mothers' parenting and toddler compliance and defiance.

OBJECTIVES: It is imperative that individual differences in the cultural contexts of adolescent mothers, whose parenting is often linked to poor child outcomes, be better understood, especially among Puerto Rican-origin mothers who experience high rates of poverty. Behaviors that mothers use to elicit compliance from their children are important to investigate, because children's ability to engage in regulated, compliant behavior has long-term consequences for their adjustment. This study tested whether mothers' orientation to both American and Latino cultures influenced the associations between such maternal behaviors and compliant and defiant child behaviors. METHOD: The sample included 123 young, Puerto Rican-origin mothers and their 24-month-old toddlers. Behaviors coded from a toy cleanup task measured maternal guidance and control and child compliance and defiance, and acculturation and enculturation were measured with a self-report questionnaire. RESULTS: Maternal guidance predicted more child compliance, with no significant variations by cultural orientation; however, mothers who were more enculturated had children who were more compliant. As predicted, mothers' more frequent use of control was related to more child defiance for mothers reporting high levels of acculturation, and not for less acculturated mothers. CONCLUSIONS: Findings support the hypothesis that individual differences in cultural orientation influence variations in associations between certain maternal and child behaviors. (PsycINFO Database Record

Developmental outcomes of toddlers of young Latina mothers: Cultural, family, and parenting factors.

Children of adolescent mothers are at risk for poor developmental outcomes. This study is among the first to examine how cultural, family, and parenting factors prospectively predict the cognitive and language development of children of young Latina mothers (N=170; Mage=17.9 years). Mothers were interviewed and observed interacting with their children at 18 months (W1). Children were tested at 18 (W1) and 24 (W2) months. Mothers' cultural orientation (W1) was related to aspects of the childrearing environment (W1), which in turn had implications for the children's development (W2). Specifically, a stronger orientation toward American culture was related to higher mother-reported engagement in parenting by their own mothers (grandmothers), which in turn predicted stronger gains in cognitive and expressive language functioning from W1 to W2. A stronger Latino orientation related to the display of more directiveness and greater mother-reported engagement by the children's biological fathers; directiveness, in turn, predicted fewer gains in cognitive functioning only when father engagement was low and did not predict expressive language development. Finally, mothers' display of more positive affect, a stronger American orientation, and higher grandmother engagement uniquely predicted gains in W2 expressive language functioning. Implications for intervention are discussed.

Tabaquismo pasivo en el hogar: una invitación a la reflexión / Passive tobacco exposure in the home: an invitation for thinking

Presentamos el caso de una paciente expuesta a humo de tabaco ambiental en su hogar durante más de 35 años en un reducido espacio. Fue diagnosticada de una tumoración renal (carcinoma de células de transición de pelvis renal), siendo una causa de este tipo de tumores el consumo de tabaco. Pretendemos generar una reflexión sobre el tabaquismo pasivo en el hogar e incorporar nuestro consejo antitabaco en este sentido a nuestros pacientes. Según datos del Ministerio de Sanidad en España, se estima que la exposición al aire contaminado por el humo del tabaco en personas no fumadoras causa, cada año, la muerte alrededor de 1.498 personas (AU)

The present is the case of a female patient exposed to environmental tobacco smoke in her home for more than 35 year-old in a reduced space. She was diagnosed a renal tumor (transitional cells carcinoma of the renal pelvis), being this type of tumor caused by tobacco consumption. Our intention is to generate some thinking around passive tobacco exposure in the home while incorporating our anti-smoking advice to this regard to our patients. According to data from the Spanish Ministry of Health, the exposure of non-smokers to air polluted by tobacco smoke causes 1,498 deaths each year (AU)

Community screening for pre-diabetes and diabetes using HbA1c levels in high-risk African Americans and Latinos.

OBJECTIVE: To evaluate community screening using HbA1c levels in high risk African Americans and Latinos in those not known to have diabetes. DESIGN: HbA1c levels were measured in 1542 African Americans and Latinos aged > or = 40 years with one or more of the following risk factors: family history in first degree relatives, waist circumference > or = 40 inches in males or > or = 35 inches in females, and hypertension, either treatment for or a measured BP of > or = 140/ 90 mm Hg. Oral glucose tolerance tests (OGTT) were offered to those meeting the HbA1c criterion for pre-diabetes. SETTING: Churches, community health fares, senior citizen sites. PARTICIPANTS: People without known diabetes. MAIN OUTCOME MEASURES: Proportion of people meeting the HbA1c criteria for prediabetes (5.8-6.4%) and diabetes (> or = 6.5%). RESULTS: 32% had one, 50% had two and 18% had three risk factors. By HbA1c criteria, 40% had pre-diabetes and 25% had diabetes. Increased waist circumference was the most common risk factor followed by a positive family history, and lastly, hypertension. Each individual risk factor was significantly (P < .001) and progressively more common as glycemia increased. Each additional risk factor increased the odds of pre-diabetes or diabetes by 2- to 4-fold. In individuals with pre-diabetes who underwent an OGTT, 59% were normal, 35% had pre-diabetes and only 6% had diabetes. CONCLUSIONS: Community screening of high risk African Americans and Latinos with HbA1c levels identifies a large proportion of people with pre-diabetes and diabetes. Those identified with pre-diabetes are unlikely to meet the OGTT criteria for diabetes.

Maternal Depressive Symptoms and Child Behavior Problems among Latina Adolescent Mothers: The Buffering Effect of Mother-reported Partner Child Care Involvement.

We examined the relations between maternal depressive symptoms and child internalizing and externalizing problems in a sample of 125 adolescent Latina mothers (primarily Puerto Rican) and their toddlers. We also tested the influence of mother-reported partner child care involvement on child behavior problems and explored mother-reported partner characteristics that related to this involvement. Results suggested that maternal depressive symptoms related to child internalizing and externalizing problems when accounting for contextual risk factors. Importantly, these symptoms mediated the link between life stress and child behavior problems. Mother-reported partner child care interacted with maternal depressive symptoms for internalizing, not externalizing, problems. Specifically, depressive symptoms related less strongly to internalizing problems at higher levels of partner child care than at lower levels. Participants with younger partners, co-residing partners, and in longer romantic relationships reported higher partner child care involvement. Results are discussed considering implications for future research and interventions for mothers, their children, and their partners.