Promoting Diversity in the Clinical and Translational Research Workforce.

The positive impact of diversity in increasing the effectiveness of the research workforce has been undeniably demonstrated to be an essential element for achieving health equity. Diversity is also instrumental for the research workforce to advance discovery, eliminate health disparities, improve minority health and achieve effective patient-centered outcomes in the quest for better health. One of the sustainable ways to achieve diversity in the workforce is through training, education and career development of all interested individuals including minority, underserved, underrepresented and populations with special needs. A Hispanic public, academic health center, and a historically black private medical school, have joined efforts in this article to share their experiences in addressing diversity in the clinical and translational research workforce with grant support from the National Institutes of Health. The purpose of this paper is to describe how diversity has been achieved through a concerted effort to recruit and develop underrepresented junior faculty and doctoral candidates for successful careers in clinical and translational research focused on health disparities and minority health. We describe Initiatives designed to achieve diversity in recruitment and development of research teams, together with an evaluation of outcomes to determine the success of the program and its participants.

[Detection of herpes virus and human enterovirus in pathology samples using low-density arrays]. / Detección de virus herpes y enterovirus humanos mediante arrays de baja densidad en muestras de anatomía patológica.

Despite the frequency of infections with herpesviridae family, only eight subtypes affect humans (Herpex Simplex Virus types 1 and 2, Varicella Zoster Virus, Epstein-Barr Virus, Citomegalovirus and Human Herpes Virus types 6, 7 and 8). Amongst enteroviruses infections, the most important are Poliovirus, Coxackievirus and Echovirus. Symptoms can vary from mild to severe and early diagnosis is of upmost importance. Nowadays, low-density arrays can detect different types of viruses in a single assay using DNA extracted from biological samples. We analyzed 70 samples of formalin-fixed and paraffin-embedded tissue, searching for viruses (HSV-1, HSV-2, VZV, CMV, EBV, HHV-6, HHV-7 y HHV-8, Poliovirus, Echovirus and Coxsackievirus) using the kit CLART® ENTHERPEX. Out of the total of 70 samples, 29 were positive for viral infection (41.43%), and only 4 of them showed cytopathic effect (100% correlation between histology and the test). 47.6% of GVHD samples were positive for virus; 68.75% of IBD analyzed showed positivity for viral infection; in colitis with ulcers (neither GVHD nor IBD), the test was positive in 50% of the samples and was also positive in 50% of ischemic lesions. The high sensitivity of the technique makes it a useful tool for the pathologist in addition to conventional histology-based diagnosis, as a viral infection may affect treatment.

Detección de virus herpes y enterovirus humanos mediante arrays de baja densidad en muestras de anatomía patológica / Detection of herpes virus and human enterovirus in pathology samples using low-density arrays

A pesar de que las infecciones por virus de la familia Herpesviridae son muy frecuentes, tan solo 8 subtipos afectan al hombre (virus herpes simplex tipos 1 y 2, virus varicela-zoster, virus Epstein-Barr, citomegalovirus y virus herpes humano tipos 6, 7 y 8). Entre las infecciones causadas por enterovirus destacan el Poliovirus, el Coxsackievirus y el Echovirus. La clínica de estas infecciones puede variar desde un cuadro leve a una afectación sistémica grave, siendo importante el diagnóstico precoz. En la actualidad, la técnica de arrays de baja densidad es capaz de detectar diferentes virus en un mismo análisis a partir de ADN extraído de muestras biológicas. En nuestro estudio empleamos el kit CLART® ENTHERPEX, con el que analizamos 70 muestras de tejido fijado en formol y parafinado, investigando la presencia de virus (VHS-1, VHS-2, VVZ, CMV, VEB, VHH-6, VHH-7 y VHH-8, Poliovirus, Echovirus y Coxsackievirus). De las 70 muestras analizadas, en 29 (41,43%) se detectó infección vírica; solo 4 de las muestras positivas presentaban lesión citopática (correlación del 100% entre el análisis histológico y el test). Las muestras de EICH mostraron un 47,6% de positividad, en EII se detectaron un 68,75% de positivos, en colitis no EII con úlceras se detectó un 50% de positividad, y un 50% de positividad en las lesiones isquémicas. La técnica empleada tiene una alta sensibilidad, por lo que sería útil realizar la determinación como ayuda al diagnóstico basado en la histología, ya que en ocasiones la presencia de infección vírica puede modificar el manejo terapéutico (AU)

Despite the frequency of infections with herpesviridae family, only eight subtypes affect humans (Herpex Simplex Virus types 1 and 2, Varicella Zoster Virus, Epstein-Barr Virus, Citomegalovirus and Human Herpes Virus types 6, 7 and 8). Amongst enteroviruses infections, the most important are Poliovirus, Coxackievirus and Echovirus. Symptoms can vary from mild to severe and early diagnosis is of upmost importance. Nowadays, low-density arrays can detect different types of viruses in a single assay using DNA extracted from biological samples. We analyzed 70 samples of formalin-fixed and paraffin-embedded tissue, searching for viruses (HSV-1, HSV-2, VZV, CMV, EBV, HHV-6, HHV-7 y HHV-8, Poliovirus, Echovirus and Coxsackievirus) using the kit CLART® ENTHERPEX. Out of the total of 70 samples, 29 were positive for viral infection (41.43%), and only 4 of them showed cytopathic effect (100% correlation between histology and the test). 47.6% of GVHD samples were positive for virus; 68.75% of IBD analyzed showed positivity for viral infection; in colitis with ulcers (neither GVHD nor IBD), the test was positive in 50% of the samples and was also positive in 50% of ischemic lesions. The high sensitivity of the technique makes it a useful tool for the pathologist in addition to conventional histology-based diagnosis, as a viral infection may affect treatment (AU)

Definition and application of neuropsychological test battery to evaluate postoperative cognitive dysfunction.

OBJECTIVE: To investigate the adequacy of the neuropsychological test battery proposed by the International Study of Postoperative Cognitive Dysfunction to evaluate this disorder in Brazilian elderly patients undergoing surgery under general anesthesia. METHODS: A neuropsychological assessment was made in patients undergoing non-cardiac surgery under general anesthesia, aged over 65 years, literate, with no history of psychiatric or neurological problems and score on the Mini Mental State Examination at or above the cutoff point for the Brazilian population (>18 or >23) according to the schooling level of the subject. Eighty patients were evaluated by a trained team of neuropsychologists up to 24 hours before elective surgery. RESULTS: Among the patients evaluated, one was excluded due to score below the cutoff point in the Mini Mental State Examination and two did not complete the test battery, thus remaining 77 patients in the study. The mean age was 69±7.5 years, and 62.34% of the subjects had ±4 years of study. The subjects had significantly lower averages than expected (p<0.001) for normative tables on neuropsychological tests. CONCLUSION: The study demonstrated the applicability of the instruments in the Brazilian elderly and low schooling level population, but suggested the need to determine cutoff points appropriate for these individuals, ensuring the correct interpretation of results. This battery is relevant to postoperative follow-up evaluations, favoring the diagnosis of postoperative cognitive dysfunction in patients undergoing different types of surgery and anesthetic techniques.

Definition and application of neuropsychological test battery to evaluate postoperative cognitive dysfunction / Definição e aplicação de bateria de testes neuropsicológicos para avaliação de disfunção cognitiva pós-operatória

Objective To investigate the adequacy of the neuropsychological test battery proposed by the International Study of Postoperative Cognitive Dysfunction to evaluate this disorder in Brazilian elderly patients undergoing surgery under general anesthesia. Methods A neuropsychological assessment was made in patients undergoing non-cardiac surgery under general anesthesia, aged over 65 years, literate, with no history of psychiatric or neurological problems and score on the Mini Mental State Examination at or above the cutoff point for the Brazilian population (>18 or >23) according to the schooling level of the subject. Eighty patients were evaluated by a trained team of neuropsychologists up to 24 hours before elective surgery. Results Among the patients evaluated, one was excluded due to score below the cutoff point in the Mini Mental State Examination and two did not complete the test battery, thus remaining 77 patients in the study. The mean age was 69±7.5 years, and 62.34% of the subjects had ±4 years of study. The subjects had significantly lower averages than expected (p<0.001) for normative tables on neuropsychological tests. Conclusion The study demonstrated the applicability of the instruments in the Brazilian elderly and low schooling level population, but suggested the need to determine cutoff points appropriate for these individuals, ensuring the correct interpretation of results. This battery is relevant to postoperative follow-up evaluations, favoring the diagnosis of postoperative cognitive dysfunction in patients undergoing different types of surgery and anesthetic techniques. .

Objetivo Investigar a adequação da bateria neuropsicológica proposta pelo International Study of Postoperative Cognitive Dysfunction para a avaliação de disfunção cognitiva pós-operatória em pacientes idosos brasileiros submetidos à cirurgia sob anestesia geral. Métodos Foi realizada uma avaliação neuropsicológica em pacientes submetidos a cirurgias não cardíacas sob anestesia geral, com idade >65 anos, alfabetizados, sem histórico de problemas psiquiátricos ou neurológicos e com pontuação no Miniexame do Estado Mental igual ou superior ao ponto de corte para a população brasileira (>18 ou >23) de acordo com a escolaridade do sujeito. Oitenta pacientes foram avaliados por equipe treinada de neuropsicólogos até 24 horas antes da cirurgia de caráter eletivo. Resultados Dentre os pacientes avaliados, um foi excluído por apresentar pontuação abaixo do ponto de corte no Miniexame do Estado Mental e dois não completaram a bateria de testes, permanecendo 77 pacientes no estudo. A média de idade foi de 69±7,5 anos, com 62,34% dos sujeitos, com ±4 anos de estudo. Os sujeitos apresentaram médias significativamente inferiores ao esperado (p<0,001) para tabelas normativas nos testes neuropsicológicos. Conclusão O estudo demonstrou a aplicabilidade dos instrumentos na população brasileira idosa e de baixa escolaridade, mas sugeriu a necessidade de determinação de pontos de corte adequados a essa população, garantindo a correta interpretação de resultados. Tal bateria é relevante para avaliações de seguimento pós-cirúrgico, favorecendo o diagnóstico de disfunção cognitiva pós-operatória em pacientes submetidos a diferentes tipos de cirurgia e técnicas anestésicas. .

Exposure assessment to glyphosate of two species of annelids.

Adult mortality, biomass, fecundity and viability of cocoons were studied in Eisenia fetida and Octolasion tyrtaeum, in response to glyphosate exposure in soil. Exposure tests were carried out following USEPA procedure, with five concentrations of glyphosate in soil and a control. O. tyrtaeum was more sensitive to the highest concentration of glyphosate (50,000 mg kg(-1)), with 100 % mortality by day 7 of exposure, compared with 71 % for E. fetida. Although biomass of O. tyrtaeum was significantly different between the control and 5,000 mg kg(-1) dose at day 14, E. fetida was not affected at that concentration, and only showed a significant weight loss after 7 days of exposure to 50,000 mg kg(-1). Adverse effects upon adult fecundity and cocoon viability were observed at glyphosate concentrations of 5,000 mg kg(-1) and above. Adverse effects were observed at concentrations that greatly exceeded the recommended field application rates of glyphosate.

A needs assessment of health department employees in Puerto Rico and Florida.

Public health training centers were established to enhance competencies in skills required to meet 21st-century public health challenges. In 2011, the Puerto Rico-Florida Public Health Training Center conducted surveys to assess the training needs of two populations of public health workers serving Hispanic communities: Florida Department of Health employees and workers at the regional and central offices of the Puerto Rico Department of Health. The two surveys were similar, but not identical in content and administration. A 52.6% response rate was achieved in the Commonwealth of Puerto Rico, where limited computer access necessitated use of a pen-and-paper survey. A 20.7% response rate was achieved in Florida, where an online survey was used and incomplete responses were problematic. Puerto Rico respondents (n = 1,414) were similar in age (Mdn age = 48 years) to Hispanic Florida respondents (n = 546, Mdn age =45 years). They also reported higher levels of academic achievement and more years of experience in public health. Nevertheless, self-assessed public health competency scores were in the low- to mid-range for Hispanic respondents in both locales. Although self-assessed training priorities differed, Hispanic employees in both jurisdictions preferred hands-on and face-to-face training to distance learning. Findings indicate a need for training based on adult learning theory, targeted to entry-level employees, and addressing the top five self-assessed training needs, especially health promotion and disease prevention and public health law and policy, which emerged as priority training areas in both survey populations.

No effects of low and high consumption of dairy products and calcium supplements on body composition and serum lipids in Puerto Rican obese adults.

OBJECTIVE: Epidemiologic studies have shown that a high calcium intake is related to lower body weight, fat, and serum lipids in obese individuals. However, clinical studies have shown inconclusive results. The present study was conducted to determine if dairy or calcium supplementation alters body composition or serum lipids in Puerto Rican obese adults without dietary energy restriction or exercise. METHODS: A 21-wk randomized clinical trial was conducted in 30 obese adults, aged 21-50 y, with usual calcium intakes <700 mg/d. Subjects were randomly assigned to the following: high dairy (∼ 1300 mg/d of calcium from dairy products by substituting foods); high calcium (∼ 1300 mg/d of calcium; ∼ 700 mg/d from diet and 600 mg/d from a supplement); or placebo. Subjects were asked to continue their established dietary intake (except for the high dairy group) and their physical activity during the study. Body weight was measured monthly; body fat, bone, and serum lipids (total cholesterol, high-density lipoprotein, low-density lipoprotein, and triacylglycerol) were measured at baseline and at 21 wk. Pairwise differences in study endpoints among the groups were assessed using ANOVA and post-hoc analysis. RESULTS: Grand mean calcium intake was 1200 ± 370 (median 1187) mg/d in the high dairy group, 1171 ± 265 (median 1165) mg/d in the high calcium group, and 668 ± 273 (median 691) mg/d in the control group, which was significantly lower compared to the two treatment groups (P < 0.001). There were no significant group effects in any of the outcome variables. CONCLUSION: A high dairy or calcium diet alone did not alter body composition or serum lipids profile in a sample of Puerto Rican obese adults.

Inequidad en personas que padecen de Tuberculosis. Estudio piloto en tres Centros de Salud de Lima (Perú) / Inequity in people ill with tuberculosis: Pilot study in three centres of health from Lima

Objetivo. Identificar la magnitud de pobreza de personas con tuberculosis y su cambio a lo largo de la Estrategia Sanitaria Nacional de Tuberculosis (ESNT). Metodología. Estudio piloto de una cohorte histórica de pacientes ingresados a la ESNT a través de evaluaciones socioeconómicas al momento en que el paciente ingresa a la estrategia, al culminar la primera fase del tratamiento y fin del tratamiento. Resultados. 45% de los pacientes presenta pobreza extrema, otro 45% es pobre y un 9.09% es no pobre, según NBI. Según valor de la canasta familiar básica, 76.76% se encuentra en pobreza extrema, 18,18% en pobreza y 6.06% es no pobre. La pobreza extrema incrementó a la mitad del tratamiento a 81.82% y se mantuvo hasta el final. El índice de Concentración al inicio de la estrategia fue 0.24 y a la mitad y final de la estrategia fue 0.22. Conclusiones. La magnitud de pobreza de las personas con tuberculosis incrementa ligeramente durante su permanencia en la ESNT (AU)

Objective. Identify the magnitude of persons' poverty with tuberculosis and his change throughout the ESNT. Methods. Pilot study of a patients' historical cohort deposited the ESNT across socioeconomic evaluations to the moment which the patient joins to the strategy, on having reached the first phase of the treatment and end of the treatment. Results. 45 % of the patients presents extreme poverty, other one 45 % is poor and 9.09 % is not poor, according to NBI. According to value of the familiar basic basket, 76.76 % is in extreme poverty, 18,18 % in poverty and 6.06 % is not poor. The extreme poverty increased to the half of the treatment 81.82 % and was kept until the end. The index of Concentration to the beginning of the strategy was 0.24 and to the half and end of the strategy was 0.22. Conclusions. The magnitude of poverty of the persons with tuberculosis increases lightly during his permanency in the ESNT (AU)

Provider turnover in public sector managed mental health care.

The present study examines the extent of turnover in mental health provider networks within public sector managed mental health care over a 1-year period and its association to provider and practice characteristics. Telephone interviews were conducted with a sample of mental health services providers listed the previous year in the networks of the 3 public sector managed mental health care organizations operating in Puerto Rico. Thirty-one percent of respondents had dropped out of networks. The drop-out rate was significantly associated (P < or = .05) with increasing number of years in practice and decreasing years under contract. A nonsignificant trend was observed, suggesting that providers with subspecialty training are less likely to drop out. The results may be signaling an emerging problem in public sector managed mental health care. Stability of provider networks should be monitored by state agencies contracting out mental health care.

Inequalities in use of specialty mental health services among Latinos, African Americans, and non-Latino whites.

OBJECTIVE: The authors investigated whether there are disparities in the rates of specialty mental health care for Latinos and African Americans compared with non-Latino whites in the United States. METHODS: Data were analyzed from the 1990-1992 National Comorbidity Survey, which surveyed a probability sample of 8,098 English-speaking respondents aged 15 to 54 years. Respondents self-identified their race or ethnicity, yielding a sample of 695 Latinos, 987 African Americans, and 6,026 non-Latino whites. Data on demographic characteristics, insurance status, psychiatric morbidity, whether the respondent lived in an urban or a rural area, geographic location, income, and use of mental health services were determined for each ethnic or racial group. Logistic regression analyses were used to examine the associations between ethnic or racial group and use of specialty services, with relevant covariates adjusted for. RESULTS: Significant differences between ethnic groups were found in demographic characteristics, geographic location, zone of residence, insurance status, income, wealth, and use of mental health services. The results indicated that poor Latinos (family income of less than $15,000) have lower access to specialty care than poor non-Latino whites. African Americans who were not classified as poor were less likely to receive specialty care than their white counterparts, even after adjustment for demographic characteristics, insurance status, and psychiatric morbidity. CONCLUSIONS: To understand ethnic or racial disparities in specialty care, the effects of ethnicity or race should be analyzed in combination with variables related to poverty status and environmental context. Further research needs to address the complex construct of social position in order to bridge the gap in unmet need in specialty care.