External relationships as implementation determinants in community-engaged, equity-focused COVID-19 vaccination events.

Background: While relationships and connectedness among organizations have been included in implementation theories, models, and frameworks, the increased attention to health equity in implementation science raises the urgency of understanding the role of relationships external to the implementing organization. This paper addresses this gap through an exploration of the role of external relationships in community-based, equity-focused interventions. Methods: This study focuses on an equity-focused, community-based COVID-19 vaccination intervention in Arkansas, drawing upon long-term community-engaged relationships among University of Arkansas for Medical Sciences and the Hispanic and Marshallese Islander communities. We used an exploratory qualitative descriptive design to examine barriers and facilitators to implementation of COVID-19 vaccination events analyzing in-depth qualitative interviews with implementation team members (n = 17). Results: All participants described pre-existing relationships among the implementing organization, partner organizations, and communities as a key implementation determinant for this equity-focused program. At the inter-organizational level, external relationships included formal connections and informal relationships among staff (e.g., communication channels from prior partnerships). At the individual level, strong external relationships with the community were facilitators leveraging long-term engagement, community familiarity, and staff from the communities of focus. Strong external relationships facilitated program reach in underserved communities through three mechanisms: (1) reduced time required to establish functional working relationships among partners; (2) accessibility and cultural congruence of health services; and (3) increased trust among community members. Barriers to implementation also existed in external relationships, but had less influence than facilitators. Conclusions: Achieving health equity in implementation science requires greater understanding of external relationships as implementation determinants. This exploratory study makes a significant contribution to the literature by describing the types of external relationships that facilitate equitable implementation and identifying the mechanisms through which they may work. We argue that approaches to community engagement drawn from community-engaged research approaches may be useful, as these processes require investment in building/maintaining formal and informal organizational and interpersonal relationships. Further research is needed to understand connections among external relationships and other implementation determinants.

Scientific facts improve cannabis perception and public opinion: results from Sinaloa, México.

Cannabis, the most prevalent drug in Latin America, has long been associated with the state of Sinaloa, Mexico, known for its cultivation and distribution. Despite increasing global acceptance, cannabis use remains stigmatized in Mexican society, driven by perceptions of it as a highly psychoactive and addictive substance lacking medicinal or industrial value. This study investigates the impact of scientific information on societal perceptions of cannabis in Sinaloa. A large convenience sample of 3162 individuals from Sinaloa participated in this research, responding to a questionnaire on cannabis consumption and attitudes. Participants were then subjected to an intervention consisting of an informative briefing based on the documents "Using Evidence to Talk About Cannabis" and "State of the Evidence: cannabis use and regulation" by the International Centre for Science in Drug Policy. After the intervention, participants' attitudes were immediately reevaluated through the same questionnaire, allowing for a comparison of pre- and post-intervention responses. The results indicate that the intervention (providing scientific information) significantly influenced attitudes toward cannabis, with education and age playing prominent roles in its effectiveness. Notably, the intervention fostered more positive or more neutral attitudes, potentially reducing stigma and promoting a better-informed perspective on cannabis. This study highlights the pivotal role of evidence in shaping informed citizens' views, while underscoring the importance of countering misinformation for societal progress. These findings have significant implications for forthcoming cannabis policy modifications in Mexico, emphasizing the necessity of engaging knowledgeable individuals in policy decisions to address the violence and inequalities associated with the illicit drug trade, particularly in Sinaloa.

"I am hesitant to visit the doctor unless absolutely necessary": A qualitative study of delayed care, avoidance of care, and telehealth experiences during the COVID-19 pandemic.

The COVID-19 pandemic has disrupted the health care system, resulting in decreased health care utilization. During the pandemic, some patients chose to postpone clinic visits or avoid them altogether while health care providers concurrently scaled back their services. As a result, health care has shifted to a greater reliance on telehealth and virtual care. This study uses a qualitative descriptive design, focused on providing summaries of participant experiences of health care and telehealth utilization during the COVID-19 pandemic. Three primary themes emerged during analysis: delayed health care, avoidance of care, and experiences of telehealth. Sub-themes of delayed health care included care delays and scheduling difficulties. Participants reported avoidance of health care due to fear of COVID-19 infection, as well as general changes to care-seeking behaviors. Participants also reported positive experiences with telehealth, with some respondents noting limitations of telehealth systems, such as limitations on procedures and patient-centered monitoring of chronic illness. Our findings support studies that have found both health care delays and changes in health care utilization patterns during the pandemic. Most importantly, this study expands the literature concerning links between fear of COVID-19 and altered care-seeking behaviors, which is the first study to do so focusing on these concerns in the participants' own words. Finally, while telehealth is promising in preserving continuity of care during pandemics, long-term integration into the health care system is not without challenges, and this study provides insights into how patients experienced telehealth during COVID-19 in their own words. Data collection, survey design, and research priorities for this study were based on input from ongoing community partnerships.

Increased Bloodborne Pathogen Exposure Hotline Utilization During the COVID-19 Pandemic: An Unexpected Phenomenon.

Background: Mitigating bloodborne pathogen exposure (BBPE) risk among healthcare workers is a major focus of hospital-based occupational health programs. The COVID-19 pandemic has placed added demands on occupational health services for healthcare workers. Its impact on BBPE incidence is unreported. Methods: As part of quality improvement efforts, we examined BBPE case incidence at two affiliated health centers during a 24-month period, 12 months preceding and following the COVID-19 pandemic onset. We used Year 1 to Year 2 change in incidence at the larger health center as the referent value to generate predicted incidence rates at the study health center. We tested the ratio of observed to predicted values at the study health center as a Poisson variable to its expectation. We defined a BBPE consistent with the Occupational Safety and Health Administration (OSHA) Bloodborne Pathogens Standard. Results: The BBPE case incidence at Health Center One (HC1), totaled 46 cases in Year 1, increasing 19% to 55 cases in Year 2. The cumulative incidence at Health Center Two (HC2), the referent facility, was 664 cases in Year 1, declining 24% to 503 in Year 2. The ratio of 55 events at HC1 to the expected incidence of 35, based on the experience at HC2, was 1.6 (p < .05). Discussion/Applications to Practice: The incidence of BBPE events at HC1 paradoxically increased during the COVID-19 pandemic, contrasting to the expected decrease that we observed at HC2. These data suggest that during times of increased stress to employee healthcare delivery from an infectious disease outbreak, the burden of ongoing practice demands may increase.

Use of Community-Based Participatory Research Partnerships to Reduce COVID-19 Disparities Among Marshallese Pacific Islander and Latino Communities - Benton and Washington Counties, Arkansas, April-December 2020.

Marshallese and Latino communities in Benton and Washington counties, Arkansas, were disproportionately affected by COVID-19. We evaluated the effectiveness of a comprehensive community-based intervention to reduce COVID-19 disparities in these communities. We examined all laboratory-confirmed COVID-19 cases in the 2 counties reported from April 6, 2020, through December 28, 2020. A 2-sample serial t test for rate change was used to evaluate changes in case rates before and after implementation of the intervention. After implementation, the proportions of cases among Marshallese and Latino residents declined substantially and began to align more closely with the proportions of these 2 populations in the 2 counties. Infection rates remained lower throughout the evaluation period, and weekly incidence also approximated Marshallese and Latino population proportions. Leveraging community partnerships and tailoring activities to specific communities can successfully reduce disparities in incidence among populations at high-risk for COVID-19 .

Selective Deficits in Contingency-Driven Ethanol Seeking Following Chronic Ethanol Exposure in Male Mice.

BACKGROUND: People with alcohol use disorders exhibit an overreliance on habitual response strategies which may result from a history of chronic alcohol exposure. Although habits are defined by behavior that persists despite changes in outcome value and in action-outcome relationships, most research investigating the effects of ethanol exposure on habits has focused only on outcome devaluation. A clear understanding of the effects of chronic alcohol exposure on the ability to flexibly update behavior may provide insight into the behavioral deficits that characterize alcohol use disorders. METHODS: To dissociate the effects of chronic intermittent ethanol (CIE) exposure on contingency-mediated sucrose versus ethanol seeking, adult male C57Bl/6J mice were assigned to 2 separate experiments. In the first experiment, mice were trained to self-administer ethanol prior to 2 cycles of interleaved CIE exposure by vapor inhalation. In a second experiment, mice were trained to self-administer sucrose and ethanol in separate training sessions prior to 4 cycles of interleaved CIE. The use of contingencies to mediate reward seeking was assessed using a contingency degradation paradigm. RESULTS: In mice trained to self-administer only ethanol, 2 weeks of CIE resulted in escalated self-administration. At this time point, CIE-exposed mice, but not air-exposed controls, exhibited ethanol seeking that was insensitive to changes in action-outcome contingency, consistent with habitual ethanol seeking. In mice trained to self-administer ethanol and sucrose rewards in sequential sessions, no escalation in self-administration across 4 weeks of CIE was observed. Under these conditions, neither Air- nor CIE-exposed mice reduced ethanol seeking in response to contingency degradation. In contrast, sucrose seeking remained goal-directed. CONCLUSIONS: Our results suggest that chronic ethanol exposure impairs contingency-driven ethanol seeking more readily than sucrose-seeking behavior. Further, these findings indicate that the transition from contingency-mediated ethanol seeking occurs more rapidly than for sucrose seeking under similar ethanol exposure conditions.

Mercúrio nos Garimpos da Terra Indígena Yanomami e Responsabilidades / Mercury-Based Mining in Yanomami Indigenous Lands and Accountabilities / Mercurio en la Minería de las Tierras Indígenas Yanomami y Responsabilidades

Mercury-based gold exploitation in Amazonian indigenous lands is illegal and leads to socio-environmental impacts. Yanomami people living near mining areas in Uraricoera River are exposed to contamination by mercury, which is a metal with bioaccumulation properties. The aims of the current study are to analyze the interdisciplinary nature of mercury-based placer mining carried out in Yanomami Indigenous Land, Roraima State, as well as to evaluate State agencies' responses to this phenomenon. Based on bibliographical and documentary survey of qualitative approach, which involved Yanomami's accounts, as well as police, administrative and judicial procedures implemented from 2013 to 2017, it was possible perceiving intense use of mercury in, and damages caused by, this illicit activity, as well as insufficient state action. There are divergences between protection and responsibilities described in the Brazilian legal system and the herein investigated illegal phenomenon, which violates indigenous rights, as well as scientific and ethical imperatives that can lead to the end of the world and of the Yanomami people.

La explotación de oro en tierras indígenas en la Amazonia utilizando mercurio, es clandestina y causa impactos socioambientales. Los yanomami cerca de las minas del río Uraricoera están expuestos a la contaminación por mercurio, un metal con propiedades de bioacumulación. Se objetiva análisis de carácter interdisciplinario del uso del mercurio en las garimpos de la Tierra Indígena Yanomami, en Roraima, así como evaluar las respuestas de los órganos de Estado al fenómeno. A partir del levantamiento bibliográfico y documental de un enfoque cualitativo, involucrando la voz Yanomami y procedimientos policiales, administrativos y procesos judiciales de 2013 a 2017, se percibió intenso uso de mercurio y daños de la actividad ilícita, con insuficiente acción estatal. Hay divergencias entre la protección y responsabilidades inscritas en el orden jurídico brasileño y el fenómeno clandestino estudiado, en violación a las voces indígenas, científicas y el imperativo ético, que pueden llevar al fin del mundo y del pueblo Yanomami.

A exploração de ouro em terras indígenas na Amazônia, com uso de mercúrio, é clandestina e causa impactos socioambientais. Os Yanomami próximos aos garimpos do rio Uraricoera estão expostos à contaminação pelo mercúrio, metal com propriedades de bioacumulação. Objetiva-se análise de caráter interdisciplinar do uso do mercúrio nos garimpos da Terra Indígena Yanomami, em Roraima, bem como avaliar as respostas dos órgãos de Estado ao fenômeno. A partir do levantamento bibliográfico e documental de abordagem qualitativa, envolvendo a voz indígena Yanomami e procedimentos policiais, administrativos e processos judiciais de 2013 a 2017, percebeu-se intenso uso de mercúrio e danos da atividade ilícita, com insuficiente ação estatal. Há divergências entre a proteção e responsabilidades inscritas na ordem jurídica brasileira e o fenômeno clandestino estudado, em violação às vozes indígenas, científicas e a imperativo ético, que coadunam na possibilidade de prejuízos e no fim do mundo e do povo Yanomami.

Protein and surface expression of HCN2 and HCN4 subunits in mesocorticolimbic areas after cocaine sensitization.

The Ih is a mixed depolarizing current present in neurons which, upon activation by hyperpolarization, modulates neuronal excitability in the mesocorticolimbic (MCL) system, an area which regulates emotions such as pleasure, reward, and motivation. Its biophysical properties are determined by HCN protein expression profiles, specifically HCN subunits 1-4. Previously, we reported that cocaine-induced behavioral sensitization increases HCN2 protein expression in all MCL areas with the Ventral Tegmental Area (VTA) showing the most significant increase. Recent evidence suggests that HCN4 also has an important expression in the MCL system. Although there is a significant expression of HCN channels in the MCL system their role in addictive processes is largely unknown. Thus, in this study we aim to compare HCN2 and HCN4 expression profiles and their cellular compartmental distribution in the MCL system, before and after cocaine sensitization. Surface/intracellular (S/I) ratio analysis indicates that VTA HCN2 subunits are mostly expressed in the cell surface in contrast to other areas tested. Our findings demonstrate that after cocaine sensitization, the HCN2 S/I ratio in the VTA was decreased whereas in the Prefrontal Cortex it was increased. In addition, HCN4 total expression in the VTA was decreased after cocaine sensitization, although the S/I ratio was not altered. Together, these results demonstrate differential cocaine effects on HCN2 and HCN4 protein expression profiles and therefore suggest a diverse Ih modulation of cellular activity during cocaine addictive processes.

Current and newer agents for hypertensive emergencies.

Hypertension is an increasingly prevalent chronic illness. The condition may present as a hypertensive crisis, and this entity may be further categorized as either hypertensive emergency or urgency. As the presentation is quite variable and is dependent upon the specific end-organ injury, a thorough history and examination are necessary. Once the underlying pathology is known, a target blood pressure can be determined and a specific therapeutic agent selected. The choice of most appropriate agent must take into consideration coexisting morbidities, desired rate of blood pressure decline, monitoring capabilities of the environment, and experience of the clinician. In hypertensive emergencies, the therapeutic goal is to protect remaining end-organ function, reduce the risk of complications, and thereby improve patient outcomes. This article reviews commonly used antihypertensive medications as well as evidence-based recommendations for state-of-the-art treatment for hypertensive emergencies.

[Urinary calcium and bone turnover markers]. / Correlación de calciurias con marcadores bioquímicos de reestructuración ósea.

OBJECTIVE: To know the relationship between bone turnover markers and urinary calcium excretion with and without oral calcium load in postmenopausal and young women. PATIENTS AND METHOD: A cross-sectional study in 100 women (50 with normal menstrual cycle and 50 postmenopausal). After 5 days with a specific diet, urine of 24 hours, 2 hours in fasting, and 4 hours after oral calcium load was collected (the last urine collection was only done in 20 patients in each group. In these patients, an x-ray absorptiometry of distal forearm and vitamin D levels were evaluated too). Calcium, alkaline phosphatase, calcitonin, parathormone, N-telopeptides of type I collagen, and osteocalcin serum levels were measured in fasting. Creatinine and calcium were measured in urine to obtain the Ca/cr index. RESULTS: Postmenopausal women had lower calcitonin levels while the Ca/cr index of 2 hours in fasting was higher than the eumenoreic women. We found significant correlation between Ca/cr index of 2 hours with age (R = .21; p = .04), parathormone (R = .21; p = .04), and calcitonin levels (R = -.29; p = .005). There was not correlation with the urinary calcium excretion including the 4 hour postload collection with the biochemical markers of bone turnover or mineral bone density of distal forearm. CONCLUSIONS: The urinary Ca/Cr index of 2 hours in fasting is related to parathormone levels and has a negative relationship with calcitonin levels in postmenopausal women. However, the urinary calcium excretion after oral calcium load was not related with the bone turnover grade.